A simple procedure for general screening for functional disability in elderly patients

Article Abstract:

It has been noted that medical educators and researchers are not paying enough attention to the functional ability of patients. Functional ability, which is the ability to manage the events of everyday life, is of fundamental importance to the well-being of the patient, yet it is rarely examined with the same precision as a disease. To remedy this situation, a simple procedure which may be used by general practitioners was devised to help objectively evaluate functional ability. The test targets 11 key areas which are considered to be important in everyday life, and whose evaluation would therefore provide insight into functional ability. The screening procedure quickly tests vision and hearing and the use of the arms and legs. Weight is taken as an indicator of proper nutrition, and the patient is asked about possible incontinence. Mental status is evaluated by asking the patient to repeat the names of three simple objects, and to remember them after a few minutes. Several simple questions complete the screening by determining if the patient can navigate the home, can go shopping and cook, and has adequate social support. Although the screening does take a little time, it is not lengthy, and some time may be recovered from other facets of the physical exam. For example, a functional test of hearing may be more fruitful than the otoscopic examination of the eardrum. The authors hope that the screening test will help to focus more medical attention on the problems of daily function rather than only upon diseases. They remind the reader that the job of the physician is "to cure occasionally, to relieve often, and to comfort always". (Consumer Summary produced by Reliance Medical Information, Inc.)

Physicians (General practice), General practitioners

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Why screen for functional disability in elderly persons?

Article Abstract:

Functional ability is that which most of us take for granted; it is the ability to manage the events and routines of daily life. The medical profession often takes functional ability for granted as well, since it is largely independent of conventional diagnoses. An 80-year-old patient with congestive heart failure may be confined to a nursing home, or may be a vigorous community volunteer. In order to provide a framework for the observation of functional ability, Alvan Feinstein and his colleagues have presented a simple procedure for evaluating the functional ability of patients. The procedure, published in the May 1, 1990 issue of the Annals of Internal Medicine, is offered as a convenient starting point for the rational collection of data by the medical community, rather than as a finished product. Clinicians who routinely deal with elderly patients may wish to consider it as a potentially important addition to the medical history interview. While most physicians are trained to diagnose physical disease, such diagnoses may lead to inappropriate treatment if other aspects of the patient's life are not taken into account. Furthermore, functional ability may well have a greater impact on a patient's quality of life than any disease state. Although treating disease produces revenue, the treatment of disability may actually constitute healing the patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Old age, editorial

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Older Persons' Preferences for Site of Terminal Care

Article Abstract:

Many aged people would prefer, in the event of a terminal illness, to be treated at home, but that is not current practice. One issue important to elders but not often accounted for in the debate is care of the disabilities prior to death. Of 246 patients over 65 recently hospitalized, but not selected according to life expectancy, 118 (48%) said they would prefer terminal care in the hospital, while 106 (43%) preferred to be home, with 22 (9%) who didn't know. A deciding factor was the desire to be with family members balanced against concerns about being a burden to family members.

Psychological aspects, Statistical Data Included, Terminal care, Location, Hospice care, Home care

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