UNIT 2: COMPREHENSIVE GERIATRIC ASSESSMENT 2.2 FUNCTIONAL EXAMINATION

The assessment of the functional area is the process to gather information on the ability of the elderly to perform normal activity, and maintain independence.

The goal of functional assessment scales to determine the ability of an older person to perform activities of daily living independently activities of daily living are classified into basic activities (ADL) and instrumental (IADL). In ADLs include tasks that the person must do daily to self-care (toilet, clothing, food ...). The AIVD refer to those tasks in which the person interacts with the environment to maintain their independence (cooking, shopping, using the telephone ...) and ABVD include those that allow the individual to their collaboration in social, recreational, labor, transport and strenuous exercise.

- As the degree of functional impairment increase the risk of mortality, number of hospital admissions and length of stay, physician visits, drug consumption, the risk of institutionalization and the need for social resources.

The scales used to evaluate ADLs are:

- Index of activities of daily living (Katz Index).

- Barthel Index.

For IADL used:

- Lawton and Brody Index.

- Functional Activities Questionnaire (FAQ).

The functionality of the person is the ability to independently self-care activities that provide comfort. This deterioration is a sensitive indicator to identify a new disease and likewise can be an indicator of mortality, longer hospital stays and the need for institutionalization. It is also an indicator of active life expectancy: a greater reliance, lower life expectancy. (SK Inouyune 2000; Barrantes-Monge M, 2007). Thus these scales have predictive value for mortality, hospitalization, length of stay in rehabilitation units and discharge location.

When the patient has lost some capacity abatement it is geriatric functional and is an alert and a syndrome to investigate. This loss may be related to a disease or a related set of recent pathologies or a chronic process, whereby various problems are likely to lead to failure.

For all this, the functional assessment is the cornerstone in Geriatrics. It is necessary to assess the vital needs of the elderly sick and not just damaged organs. The assessment of functional status can be performed with support from a physiotherapist and when identifying ADL limitation should undertake a program of rehabilitation and physical reconditioning.

The Katz index when identifying dependence in ADLs, may be associated with cognitive impairment, depression or both and can be used as an indicator of depressive symptoms or a decreased life expectancy, as identified acute or chronic losses (Millan-Calenti JC 2010).

The Lawton and Brody scale used to assess physical autonomy and instrumental activities of daily living. Reliance on these activities is associated with an increased demand for health services. And the loss of these activities increases the suspicion of cognitive impairment, depression or coexistence of other diseases. (Pérez K, 2008, the iron, 2008)

REFERENCES:

• Treaty of geriatrics for residents. Spanish Society of Geriatrics and Gerontology. [Home Site] [accessed May 18, 2012] Available at: http://www.segg.es/tratadogeriatria/main.html

• Clinical Practice Guideline: Assessment Comprehensive Geriatric Gerontological Ambulatory Elderly. Mexico: Ministry of Health, 2011. Available at:http://sgm.issste.gob.mx/medica/medica_documentacion/guias_autorizadas/Geriatr%C3%ADa/IMSS-491-11-valoraci%C3%B3n%20geronto-geriatrica/IMSS-491-11-GER%20Valoraci%C3%B3n%20geronto%20geriatrica.pdf

• N Alma Rosa Cortés, Enrique Villarreal R, Galicia R Liliana, Lydia Martinez G, Vargas D Emma Rosa. Comprehensive geriatric assessment of older adults. Rev. Marrow. Chile [serial on the Internet]. 2011 Jun [cited 2013 May 26], 139 (6): 725-731. Available at: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600005&lng=es