Acute illness or a worsening chronic condition can hasten functional decline in older adults. During hospitalization, reduced mobility and other factors may rapidly decrease an older patient's ability to perform activities crucial for independent living, and the effects might be permanent. The Lawton Instrumental Activities of Daily Living (IADL) Scale assesses a person's ability to perform tasks such as using a telephone, doing laundry, and handling finances. Measuring eight domains, it can be administered in 10 to 15 minutes. The scale may provide an early warning of functional decline or signal the need for further assessment. For a free online video demonstrating use of this assessment, go to http://links.lww.com/A246.

In older adults who are hospitalized, functional decline can occur in a matter of days. This devastating outcome is a common result of the older adult's "cascade to dependency," in which normal aging changes--combined with bed rest or immobility--result in irreversible physiologic changes, poor outcomes at discharge, and for many, placement in a nursing home. Routine walking schedules, activities to prevent sensory deprivation, and timely hospital discharge are among the interventions that can help prevent functional decline.

Neuropsychiatric behaviors are common in people with Alzheimer's disease (AD) and make both professional and lay caregiving difficult. Light therapy has been somewhat successful in ameliorating disruptive behaviors. This randomized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence, frequency, severity, and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD. Light was administered for 1 hr daily (Monday-Friday) for 10 weeks. The Neuropsychiatric Inventory-Nursing Home was used to assess behavior at baseline and end of the intervention. Analyses revealed statistically significant differences between groups on agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders. The magnitude of change was small and may not represent clinically significant findings. Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness. Interventions that decrease the presence and/or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden.

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Older adults are at risk for losing functional ability during and after a hospitalization. It's often difficult to determine which patients are at highest risk and which might benefit from targeted interventions. The Hospital Admission Risk Profile, a simple screening tool, can be used to classify hospitalized older adults as being at low, intermediate, or high risk for losing the ability to perform activities of daily living, based on assessments of age, cognitive function, and the ability to perform independent activities of daily living. It's one of many tools profiled in Try This: Best Practices in Nursing Care to Older Adults, a series provided by the Hartford Institute for Geriatric Nursing at New York University's College of Nursing. For a free online video demonstrating the use of this tool, go to http://links.lww.com/A286.