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Functional Assessment of the ElderlyA Comparison of Standard Instruments With Clinical Judgment
MAJ Ellen M. Pinholt, MC, USA;
MAJ Kurt Kroenke, MC, USA;
MAJ James F. Hanley, MC, USA;
LTC Michael J. Kussman, MC, USA;
CPT Pamela L. Twyman, MC, USA;
COL John L. Carpenter, MC, USA
Arch Intern Med. 1987;147(3):484-488.
Abstract
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• Using specific instruments and scales to measure mental status, nutritional state, visual acuity, gait, and activities of daily living, we studied 79 medical inpatients aged 70 years or older. We then interviewed the patients' primary physicians and nurses and asked them to rate their patients. The prevalence of functional impairment was high: 25 (32%) of the 79 patients were mentally impaired, 31 (39%) were malnourished, 18 (23%) were visually impaired, 31 (39%) had impaired gait, and 23 (29%) had problems with continence. Although clinicians recognized severe impairments, the sensitivity of their clinical judgment was poor in detecting moderate impairment in four categories: mental status sensitivity was 28% (5/18); nutrition, 54% (14/26); vision, 27% (4/15); and continence, 42% (5/12). With clinical judgment alone, physicians and nurses correctly identify severe impairment, but the more prevalent moderate impairments in mental status, nutrition, vision, and continence are poorly recognized. Comprehensive functional assessment instruments can detect these moderate impairments, which may be remediable through early intervention.
(Arch Intern Med 1987;147:484-488)
Author Affiliations
From the Department of Medicine, Brooke Army Medical Center, San Antonio, Tex.
Footnotes
Accepted for publication Aug 18, 1986.
Read in part before the 42nd Annual American Geriatrics Society Meeting, New York, July 13, 1985.
The views expressed herein are those of the authors and do not necessarily reflect the views of the US Army or the Department of Defense.
Reprint requests to General Medicine Service (HSHE-MDM), Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200 (Dr Kroenke).
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