A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline

Abstract

Screening is a first step to identify patients at risk for functional decline and this will make it possible to treat patients who are identified so as to prevent functional decline. Because of their ability to observe and to guide the patients and the overall view they have, nurses play a key role in this process.

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

“…decline, but are not specific for functional decline in elderly patients after minor injuries. 16,17,25,26 We conducted this study of emergency physicians to define what constitutes a clinically significant functional decline six months after sustaining a minor trauma.…”

“…3,5 Approximately 10%-45% of the patients will develop a decline in function that persists up to seven months post injury. [3][4][5][6][7][8][9][10][11][12][13] Functional decline, or the reduction in ability to perform self-care activities of daily living (ADL) because of a decrement in physical functioning, [14][15][16][17] is a common and serious problem in elderly patients. 16,17 Functional decline is associated with social isolation, reduced quality of life, and death.…”

“…[3][4][5][6][7][8][9][10][11][12][13] Functional decline, or the reduction in ability to perform self-care activities of daily living (ADL) because of a decrement in physical functioning, [14][15][16][17] is a common and serious problem in elderly patients. 16,17 Functional decline is associated with social isolation, reduced quality of life, and death. 3,5,7,8,14,[18][19][20][21][22] It is also an important predictor of hospitalization, 23,24 prolonged hospital stay, 25 repeat ED visits, 7,26 and the need for home care 25 .…”

“…Moreover, functional decline is the most important predictor of admission to institutions and of disproportionate use of health services by the elderly population. 16,17,[25][26][27] It has been suggested that identification of functional decline in elderly patients is more predictive of mortality than organ damage or severity of illness. 28,29 A number of assessment scales to measure functional independence in the elderly exist, the most noteworthy of which is the Older Americans Resources and Services (OARS) ADL Scale, but such scales should not be confused with screening tools purposefully designed to identify patients at risk of functional decline.…”

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

“…84 In addition, they had slower recovery of functional abilities and longer stay in rehabilitation units. 10,85 These outcomes can lead to increased caregiving needs at home, nursing home placement, or death, 86 and may have detrimental effects on rehabilitation 64,87 and long-term outcome. 88 Functional independence in personal care activities can be measured using the motor subscale of the Functional Independence Measure (mFIM), 89 which is widely used in rehabilitation settings to assess functional limitations and changes in functional status with rehabilitation therapy.…”