A Synopsis of AFPs "Functional Decline in Older Adults"

Functional Decline in Older Adults
CATHLEEN S. COLÓN-EMERIC, MD, MHS; HEATHER E. WHITSON, MD, MHS; JULIESSA PAVON, MD; and HELEN HOENIG, MD, Duke University Medical Center, Durham, North Carolina
Am Fam Physician. 2013 Sep 15;88(6):388-394.
http://www.aafp.org/afp/2013/0915/p388.pdf

     Functional decline is the progressive inability to carry out activities of daily living. It increases with age. It is a dynamic and episodic disability due to chronic diseases, such as diabetes, dementia, cancer, obesity, vision, hearing, and other disorders.  For example, heart disease may affect aerobic activities, and a stroke may affect activities of limbs use. Synergistic effects of multiple chronic conditions is also an important factor to consider in functional decline.
     Evaluating new functional decline begins with characterizing the disability. It is necessary to find out the the time course, the associated symptoms, the compensatory strategies, and the effect the disability has on specific activities. Identifying the underlying health disorders is another part of the evaluation. The focus of the physical examination can be driven by the organ system that is affected. Identifying impairments and screening for impairments, such as mood disorders, cognitive impairments, nutrition, pain, medication side effects, and gait disorders is the next step. There are multiple tools and tests that can be done. Having the patient clasp his or her hands behind his or her neck can assess the ability for a patient to use their shoulders for ADLs, such as dressing and bathing. Having the patient get up out if a chair without using his or her arms can assess the patient's' leg strength and assess their ability to use the toilet or bathe. The get up and go test is a similar test that tests lower extremities, as well as gross motor coordination. Having a patient pick up a penny from the floor cans assess fine motor coordination, pinch strength, balance and vision. Common sensory tests include the whisper test and using a snellen eye chart. The clock drawing test can assess executive function. Common questions that you can ask the patient include (these I copied out of the article)
"Do you have trouble with stairs?"
"Are you confidently able to shower, bathe or use the toilet?"
"Who would be able to help you if you needed it?"
Other important factors include assessing social support, financial resources and environmental factors should be addressed.
     Treatment of functional decline includes increasing the patients ability and reducing demands.  This includes exercise, proper diet, oxygen supplementation, assistive devices (wheelchair, hearing aid, raised toilet seat or cane), referrals for adjunctive care (PT, OT, social worker,etc) and medical intervention (cataract surgery, more appropriate medication).  A multifocal approach is effective and proven to improve function and quality of life.