* CHAPTER 10 * FUNCTIONAL ASSESSMENT USED WITH OLDER ADULTS
Health in Old Age * Is a complex, elusive concept. * Experiencing normal developmental age changes such as gradual changes in endurance, vision, hearing & reflex timing. * Some problems in old age due to a long-term disuse of physical & mental abilities: * Back problems due to lifelong postural habits or long use of sagging mattress. * New widow may struggle to make independent decisions regarding home maintenance. * Traumatic injury may occur such as hip fracture or CVA. * Trauma, whether physical or psychological, occurs in conjunction with chronic & acute disease, normal age changes & changes due to misuse or disuse. * Snow & Rogers describe this complex combination of normal & pathologic changes in old age as a “delicate balance” of adaptation. * The multi-dimensionality of health in old age is reflected in current trends toward multi-dimensional assessment instruments & Geriatric Evaluation Units. * Most multi-dimensional assessments include physical health, functional ability, psychologic health & social parameters.
Functional Assessments Used in Occupational Therapy
Physical Self-Maintenance Scale & Instrumental Activities of Daily Living Scale * The scales represent measures of two level function, competence, the scales represent measures of two levels of function, with the IADL requiring greater neuropsychological organization than the PSMS. * Within each level, the complexity of activities is also arranged hierarchically. * IADL scale focuses on activities that are conceptualized as the next higher level of function. * The PSMS & IADL scales were used in conjunction with a morale scale & a mental status scale to measure function in GEU & control groups at a baseline, 6-month & 12-month periods.
Barthel Self-Care Index * Originally designed as a measure of function in the physically impaired, it has been used extensively in research & treatment planning with older people. * Hasselkuls described the use as an index that measures basic self-care skills of feeding, transfer, personal hygiene, toileting, bathing, ambulation, stairs, dressing, & bowel & bladder continence. * Scoring is based on observation of performance & preferential weighting has been given to items of continence & mobility. * Was used in four ways: * To help define the amount & type of personal care services required by patients to be maintained in the community * To document change over time * To better define variables associated with discharge/ placement decisions * To help clarify the impact of community health services on the ability of the family to maintain care of an older member over a long period of time.
Parachek Geriatric Behavior Rating Scale * Quick screening device of 10 multiple choice items. * Three questions on physical condition, four on general self-care, & three on social behaviors. * Each question is scored on a 5-point Likert-type scale of performance, with 1 being the most impaired. The final score is the sum of 10 individual ratings. * This scale was derived from the longer Plutchik Geriatric Rating Scale. * Group I are patients scoring in the 10-24 range; treatments include positioning, sensory stimulation, motor patterns & group process. * Group II patients scoring 25-39 range; includes self-care activities, contact with the community, & adaptation for wheelchair patients. * Group III patients are the highest functioning group with scores 40-50; they can manage most self-care activities & maybe candidates for placement in community setting.
Short Portable Mental Status Questionnaire * Is used extensively by physicians & other health personnel to detect intellectual impairment. * There are 10 questions to be asked & three or four error indicates a moderate to severe impairment.
New Instruments Developed by Occupational Therapists
Assessment of Occupational Functioning * Is an occupational device based on the model of human occupation. * It is a semi-structured interview schedule to assess physically & psychologically impaired residents in long-term treatment settings. * Is divided into six components: * Values * Personal causation * Interests * Roles * Habits * Skills * A total score between 6 & 30 may be obtained by adding the scores of six components.
Performance Assessment Self-Care Skills * Contains items which represent self-care & instrumental tasks that are relevant to independent living & that can be carried out in the clinic or the home under natural or simulated conditions. * Scoring: Is competency-based & takes into account the task itself & the teaching approach that facilitates the older person’s best performance. * Standardization: Administration & scoring of the task items are standardized by the ff instructions: * The task is named * The condition under which the task to be performed is described * The behavior needed to complete the task is described * The standard for the task accomplishment is defined * The instructions to be used are given.
Tri-level ADL Assessment * Organizes activities of daily living into the six categories of communication, food needs, dressing, hygiene, mobility & organization. * Tasks in these categories are followed through the three environmental levels of personal, home or sheltered environment & the community. * This represents an attempt to organize ADL measurements in comprehensive manner but no validity or reliability estimations have yet been done.
Assessment of Home Safety of Well Elderly * Assess awareness of more than 100 safety aspects of the home environment. * A score of 0 represents the safe environment where the factors that cause accidents would be minimum. * The highest possible raw score is 145, indicating the most dangerous environment, with factors that cause accidents being at a maximum.
Medication Management Functional Assessment Tool * “The ability to functionally manage self-administration of prescription medications is often dependent upon an individual’s emotional, cognitive & physical skills, environmental expectations, & existing or available support systems. * Knowledge of the medications is combined with actual task performance assessment such as locating medications, opening containers & bringing medication to the mouth.
* CHAPTER 11 * Pre-Vocational Assessment in Mental Health
