Functional Assessment of Older Adults in an Emergency Department

Abstract

The fast paced nature of emergency medicine often precludes assessment of patient functioning which may have significant consequences for geriatric patients including falls, functional decline and/or hospital re-admission. A rehabilitation consultation service to a hospital emergency department was implemented based on recommendations in the literature that functional assessments and a multidisciplinary approach be used with older adults. A systematic method of targeting and assessing elderly at-risk patients included a safety checklist and a comprehensive functional assessment tool. An observational study of 80 patients receiving functional assessments from rehabilitation professionals is described. Patients with high levels of disability or who lived alone prior to the emergency visit were more likely to be admitted to hospital. This study supports using multidisciplinary efforts and comprehensive functional assessments in emergency departments to guide decision-making about discharge outcome and planning for the health care needs of elderly patients.

Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma

“…There have been few studies that have evaluated use of the TUG in older patients presenting to the ED [12][13][14]. The TUG assesses immediate mobility status to inform discharge dispositions in older patients who have fallen.…”

Item analysis of the Functional Status Assessment of Seniors in the Emergency Department

“…This procedure was comparable to those employed in the domain of item analysis studies [31][32][33][34][35][36]. Socio-demographic characteristics of the participants recruited in three different ED settings were quite similar to samples of other studies conducted in ED [2][3][4][14][15][16]37,38]. This also contributed to the strength of this study.…”

“…The emergency department (ED) is an important means of accessing health services [1,2]. Over the past decade, a substantial body of literature has shown that elders visit the ED significantly more frequently than do younger individuals [3,4] and they present themselves with a unique set of problems [5], including pre-existing chronic conditions that affect cognitive status and physical function [6,7].…”

“…Governmental reports have emphasised the relevance of assessing the elderly's functional status in order to foresee their future needs [5,12]. In scientific literature, the assessment of functional status and following intervention is viewed as generating positive outcomes, including reduced physical, functional and cognitive decline and increased satisfaction with health care [2][3][4]6,7,[13][14][15][16].…”

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

“…25,36 ADL have been classified into: 1) basic activities of daily living (basic ADL), including transferring, toileting, grooming, dressing, bathing and feeding oneself; and 2) instrumental activities of daily living (IADL) that allow an individual to live independently in a community (e.g., operate a telephone). 37 …”