Comparison of Older Adults' and Occupational Therapists' Awareness of Functional Abilities at Discharge from Rehabilitation with Actual Performance in the Home

Abstract

Objectives: To compare older adults' and occupational therapists' (OTs) awareness of patients' functional abilities at discharge from inpatient rehabilitation using patient performance in the home as the criterion for functional abilities. Design: A prospective cohort study. Setting: Inpatient rehabilitation unit of a large community hospital followed by observation at home. Participants: Thirty-four older adult patients who live alone and had acute hospital admission for orthopedic, medical, or cardiopulmonary primary diagnoses followed by inpatient rehabilitation. Measurements: Patients' and OTs' perceptions of patients' abilities at hospital discharge were recorded for basic and instrumental activities of daily living (ADLs) and mobility using the Functional Autonomy Measuring System. One week following discharge, patients' functional performance was measured at home. Awareness was calculated as the difference between perceptions and performance. Results: There was greater than 82% exact agreement between patients' and OTs' perceptions for: eating, bathing, dressing, toileting, transferring and walking, but only 52% agreement for meal preparation. Patients' awareness for all ADLs and mobility was about 80% accurate except for stair-climbing, meal preparation, and medication management. OTs' awareness was greatest for tasks routinely assessed while in hospital (e.g., eating, dressing, toileting, transferring, walking and stair-climbing) and for telephone use and meal preparation. Overall patients' awareness was equal to or higher than OTs' awareness for all activities except stairclimbing, meal preparation, telephone use, and medication management. Conclusions: Awareness of functional abilities varies by activity and rater and is an important element of discharge planning for community living.

Progressive Mobility As a Team Effort in Transitional Care

“…1 The strength and endurance achieved in physical therapy extends to occupational therapy, where the focus is on the physical task of taking care of oneself. 15 The team assists the resident in acquiring skills such as independent transfers, ambulation, stairs, dressing, and decision making. The resident requires stamina to complete the activities of daily living.…”

“…16 If the resident will be living independently, cognitive potential to make safe decisions for optimal independent functioning is needed. 15 One must have the mental acuity to balance a checkbook, communicate needs effectively, schedule appointments, manage medications and treatments, and determine whether a situation warrants emergency care. 15 Knowledge about and management of medications are evaluated by the nurse.…”

“…15 One must have the mental acuity to balance a checkbook, communicate needs effectively, schedule appointments, manage medications and treatments, and determine whether a situation warrants emergency care. 15 Knowledge about and management of medications are evaluated by the nurse. If the team deems the independence at home a safety risk, the social worker assists the resident and the resident's family with strategies for supervision and support with home care services or alternative living settings.…”