Summary
Common problems in older age are characterized by difficulties with hearing, seeing, remembering, moving, or performing daily or social activities.[1] Preservation of function and independence is one of the goals of successful aging.[2] Functional status is measured by the ability of people to perform basic and instrumental activities of daily living (ADLs). Basic activities of daily living (BADLs) consist of self-care tasks and include feeding, bathing, dressing, using the toilet, personal hygiene, ability to transfer from bed to chair and back again, and walking.[3] Instrumental activities of daily living (IADLs) allow a person to live independently in a community. They include the ability to use the telephone, perform housework and laundry, shop, prepare meals, manage finances, take medications, and arrange appropriate transportation.[4] More advanced ADLs include hobbies and leisure activities.
Information on functional status can be obtained during a patient interview and typically does not require a questionnaire. Screening for geriatric syndromes helps to identify risk factors for and causes of functional impairment. Identification of such syndromes and initiation of appropriate assessment and management strategies may also foster preservation of function. Several validated screening tools have been published to screen for many of these syndromes:
Delirium: Confusion Assessment Method (CAM), Richmond Agitation Sedation Scale (RASS)
Dementia: Short Portable Mental Status Questionnaire, AD8, Mini-Cog
Depression: Geriatric Depression Scale, PHQ-9, Cornell Scale for Depression in Dementia
Malnutrition: Mini Nutritional Assessment (MNA)
Pain: Verbal Pain Descriptors, Pain Thermometer, Faces Scale for Pain
Falls: the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Algorithm provides guidance on how to screen, evaluate, and intervene in persons at risk for falls.[5] Assessment tools include: Get-Up-and-Go (timed and modified), 30-Second Chair Stand, 4-Stage Balance tests, and Functional Reach.[6][7][8][9]
Functional decline in and of itself should not be considered a geriatric syndrome but rather an indicator of the negative impact that geriatric syndromes and acute/chronic medical conditions may have on an individual. Threats to functional independence arise from physical and cognitive limitations as a process of normal aging or the accumulation of chronic illness. Management of chronic illness is a key factor in preserving function. To optimize function as a result of the aging process, physical and cognitive interventions may be used when possible. Counseling patients regarding exercise and following up with them regularly has been shown to have a positive effect on mobility and helps preserve independence in community-dwelling elders.[10] In one meta-analysis, participation in exercise was shown to increase gait speed, balance, and performance in ADLs in frail older adults.[11] Physical interventions include regular exercise, balance training, participation in resistance training (RT), and endurance training. Cognitive interventions include participating in leisure activities and in cognitively stimulating activities (cognitive training). Despite the focused nature of many of these activities, their benefits may overlap. For example, participating in cardiovascular physical activities may also benefit cognitive function.
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The evidence of the effectiveness of these interventions continues to improve over time. Aside from benefits of single interventions, evidence that multicomponent interventions to preserve function and independence (in one study, specifically looking at cognitive and physical interventions to reduce risk of dementia) continue to emerge.[12] Given the potential benefit of preserving and optimizing the functional status of older people, risk in implementing these interventions more often than not is outweighed by the benefits. Guidelines supporting such interventions have been published.[13]
Details
- Frailty
- Physical interventions
- Cognitive interventions
- Nutritional interventions
- Social interventions
- Routine medical care
Contributors
Authors
Ronan Factora, MD, FACP, AGSF
Associate Professor
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Geriatric Medicine Fellowship Program Director
Center for Geriatric Medicine, Medicine Institute
Cleveland Clinic
Cleveland
OH
Disclosures
RF declares that he has no competing interests.
Peer reviewers
Senthil R. Meenrajan, MD, MBA
Assistant Professor of Medicine
University of Florida
Jacksonville
FL
Disclosures
SRM declares that he has no competing interests.
Steven Swedlund, MD
Director
Geriatric Medicine Fellowship
Department of Geriatrics
Boonshoft School of Medicine
Wright State University
Dayton
OH
Disclosures
SS declares that he has no competing interests.
Marcel Levi, MD, PhD
Chairman
Department of Medicine
Academic Medical Center
University of Amsterdam
Amsterdam
the Netherlands
Disclosures
ML declares that he has no competing interests.
Peter Millard, MB,BS (Hons Surg), MD, PhD, FRCP
Professor of Geriatrics (Emeritus)
St George's Hospital
University of London
London
UK
Disclosures
PM declares that he has no competing interests.
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