Implementation of functional assessment scales in geriatric practice: A feasibility study

Abstract

Aim: A study was undertaken to evaluate the feasibility of functional assessment scales regarding completion rate and ability to document functional changes in geriatric rehabilitation patients. Methods: Five functional assessment scales were implemented, and used on admission and discharge as part of standard care. Results: Of 2,812 patients, 90 patients (3.2%) had no scales administered, 2,330 patients (82.9%) had between one and six scales administered and 392 (13.9%) had a complete data set (seven scales). The percentage of inpatients who were independent or almost independent in basic ADL functions improved from 30% to 60% during hospitalization; 53% had cognitive impairment, while 19% expressed depressive thoughts or depression on admission. Conclusion: Functional assessment scales were feasible in the clinical routine, gave important information on patients' functional status at baseline, and showed that patients improved their physical function considerably during hospitalization. Interdisciplinary teamwork and management affect the success of the implementation of assessment scales.

Keywords

Comprehensive geriatric assessment disability functional assessment scales interdisciplinary health team

Get full access to this article

View all access options for this article.

References

Sletvold O. , Tilvis R. , Jonsson A. , Schroll M. , Snaedal J. , Engedal K. , Schultz-Larsen K. , Gustafson Y. Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment . Dan Med Bull 1996;43:350—9.

Verbrugge LM , Jette AM The disablement process. Soc Sci Med 1994;38:1—14.

Campbell LJ , Cole KD Geriatric assessment teams. Clin Geriatr Med 1987;3:99—110.

Jonsson A. , Gustafson Y. , Schroll M. , Hansen FR , Saarela M. , Nygaard H. , Laake K. , Jonsson PV , Valvanne J. , Dehlin O. Geriatric rehabilitation as an integral part of geriatric medicine in the Nordic countries. Dan Med Bull 2003;50:439—45.

Applegate WB , Blass JP , Williams TF Instruments for the functional assessment of older patients. N Engl J Med 1990;322:1207—14.

Angus R. , Bardsley M. , Barer D. , Brocklehurst J. , Brown G. , Cooper B. , Copeland J. Standardised assessment scales for elderly people. London : Royal College of Physicians of London and British Geriatrics Society; 1992.

Pinholt EM , Kroenke K. , Hanley JF , Kussman MJ , Twyman PL , Carpenter JL Functional assessment of the elderly: A comparison of standard instruments with clinical judgment. Arch Intern Med 1987 ;147:484—8.

Miller DK , Morley JE , Rubenstein LZ , Pietruszka FM , Strome LS Formal geriatric assessment instruments and the care of older general medical outpatients. J Am Geriatr Soc 1990 ;38:645—51.

Stuck AE , Siu AL , Wieland GD , Adams J. , Rubenstein LZ Comprehensive geriatric assessment: A meta-analysis of controlled trials. Lancet 1993;342:1032—6.

10.

Shah S. , Vanclay F. , Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation . J Clin Epidemiol 1989;42:703—9.

11.

Mahoney F. , Barthel D. Functional evaluation: The Barthel Index. Maryland State Med J 1965;14:61—5.

12.

Granger CV , Albrecht GL , Hamilton BB Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index. Arch Phys Med Rehabil 1979;60:145—54.

13.

Mahoney F. , Wood O. , Barthel D. Rehabilitation of chronically ill patients: The influence of complications on the final goal. Southern Med J 1958;51:605—9.

14.

Berg, KO , W-D. , SL , Williams JI , Maki B. Measuring balance in the elderly: Validation of an instrument. Can J Public Health 1992 ;83:7—11.

15.

Riddle DL , Stratford PW Interpreting validity indexes for diagnostic tests: an illustration using the Berg balance test. Phys Ther 1999;79:939—48.

16.

Montgomery SA , Åsberg MÅ A new rating scale designed to be sensitive for depression. Br J Psychiatry 1979;134:382—389.

17.

Malt UF Montgomery Åsbergs graderingsskala for depression [Montgomery Åsbergs grading scale for depression]. Nytt om legemidler (in Norwegian) 1996;19:31—32.

18.

Folstein MF , Folstein SE , McHugh PR A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189—98.

19.

George LK , Landerman R. , Blazer DG , Anthony JC Cognitive Impairment. In: Robins LN , Regier DA , editors. Psychiatric disorders in America: the epidemiologic catchment area study. New York: Free Press; 1991, p 291—327.

20.

Collin C. , Wade DT , Davies S. , Horne V. The Barthel ADL Index: A reliability study . Int Disabil Stud 1988 ;10: 61—3.

21.

Podsiadlo D. , Richardson S. The timed `Up & Go`: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142—8.

22.

Gottfries GG , Noltorp S. , Nørgaard N. Experience with a Swedish version of the Geriatric Depression Scale in primary care centres. Int J Geriatr Psychiatry 1997;12:1029—1034.

23.

Nunnally JC , Bernstein IH Psychometric Theory. New York: McGraw-Hill; 1994.

24.

Bartko JJ , Carpenter WT, Jr . On the methods and theory of reliability . J Nerv Ment Dis 1976;163:307—17.

25.

Steadman J. , Donaldson N. , Kalra L. A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients . J Am Geriatr Soc 2003;51:847—52.

26.

Thylefors I. , Price E. , Persson TO , von Wendt L. Teamwork in Swedish neuropaediatric habilitation . Child Care Health Dev 2000;26:515—32.

27.

Hoyl MT , Alessi CA , Harker JO , Josephson KR , Pietruszka FM , Koelfgen M. , Mervis JR , Fitten LJ , Rubenstein LZ Development and testing of a five-item version of the Geriatric Depression Scale. J Am Geriatr Soc 1999;47:873—8.