All visits are opportunities to promote the patient's independence and optimal level of function. Although the specific goals of care vary from patient to patient, preserving the patient's functional status, the "sixth vital sign," is of primary importance. Functional status is the ability to perform tasks and fulfill social roles associated with daily living across a wide range of complexity.
Establishing functional status provides a baseline for making interventions that optimize the patient's level of function and for identifying geriatric syndromes that can be treated or delayed, such as cognitive impairment, falls, incontinence, low BMI, dizziness, and impaired vision and hearing. Deficits in function are now recognized as better predictors of patient outcome and mortality after hospitalization than the admitting diagnoses. In 2010, the USPSTF outlined new prevention recommendations for older adults that address the multifactorial nature of geriatric syndromes and combine recommendations on related topics, such as osteoporosis, vitamin D supplementation, and prevention of falls, so that they are "more consistent, interlinked, and comprehensive" and directed at interventions that are effective.
Your assessment of functional status begins as the patient enters the room. The 10-Minute Geriatric Screener is one of several validated and time-efficient performance-based assessment tools. The Screener is brief, has high interrater agreement, and can be easily used by office staff. It covers three important areas: cognitive, psychosocial, and physical function. It includes vision, hearing, and questions about urinary incontinence, an often hidden source of social isolation and distress. Up to 55% of community -dwelling women aged ≥65 years and 30% of men report bladder leakage, increasing to 70% of long-term nursing home residents.
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