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Focus on Frailty breakout session: Functional Assessment for People Living with Frailty

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Breakout session at #WessexFrailty19

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Focus on Frailty breakout session: Functional Assessment for People Living with Frailty

  1. 1. Functional Assessment for People Living with Frailty Lucy Elloway – Team Lead Physiotherapist – Frailty and Interface Team Queen Alexandra Hospital, Portsmouth Hospital NHS Trust (lucy.elloway@porthosp.nhs.uk Twitter: @DerhamLucy Sarah Mercer – Clinical Doctoral Research Fellow and Occupational Therapist – University of Southampton and Southern Health NHS Foundation Trust (sarah.mercer@southernhealth.nhs.uk Twitter: @pd2ot)
  2. 2. Learning Objectives  To be able to understand the purpose of functional assessment for a person living with frailty  To understand the implication of hospital admission on a person living with frailty’s function and the impact it can have  To consider the practicalities of functional assessment in community settings  To understand when to refer to a physiotherapist/occupational therapist for functional assessment
  3. 3. What is a functional assessment?  Based on Activities of Daily Living (ADLs)  Teased out from a thorough Social History – as part of Comprehensive Geriatric Assessment (CGA)  The functional assessment element of the CGA compromises of: gait, balance, abilities to carry out activities of daily living (both fundamental and basic) and activity/exercise status.  Bed transfers  Sit to stand  Mobility  Washing and dressing  Toileting  Kitchen assessment
  4. 4. Who should receive a functional assessment?
  5. 5. When should a therapist be involved?  When the situation is complex:  Physiological/cognitive personal factors  Environmental barriers  Social complexity  Once you’ve identified the issues:  For advice/second opinion  For specific physiotherapy or occupational therapy intervention.  Falls  Practice guidance states that functional assessment relating to falls at home is completed by an occupational therapist (Royal College of Occupational Therapists, 2015)  Effective group exercise programmes have been shown to reduce falls by 29% and the risk of falls by 15% (Chartered Society of Physiotherapists, 2014)
  6. 6. Why complete a functional assessment?  Frailty is associated with increased hospital admissions and poorer outcomes (Coelho et al, 2015)  but functional assessment highlights key areas for intervention, which can reduce a person’s frailty status (Woo, Leung and Morley, 2012; Trevisan et al., 2017).  Hospital perspective:  The quicker we assess a frail persons function whilst in hospital the better the outcome will be for that patient.  Prevention of hospital based deconditioning  Link to quality of life and mental well being
  7. 7. Gait Timed Up and Go  Starts with patient sitting in chair with arms  Measure 3 metres and mark a spot on floor  On go, the patient must stand up, walk to the marked point, return to the chair and sit down  You must time how long it takes to the patient to complete this activity. 6 minute walk test  Used to measure endurance  Measure distance of 30m  Place chairs at either end  Object is to walk as far as you can in 6 minutes  It is recommended that you measure HR whilst performing this in order to see how the patient responds to increase demands on their body
  8. 8. Balance  75% of over 75s have reduced balance which will increase their risk of falls  Timed Unsupported Stand (TUSS) – static balance  Supportive environment – something in front/behind  Begin timing as the patient lets go of supporting surface  Stop timing as soon a they have to steady themselves  Can modify for one handed or two handed  Turn 180 – dynamic balance  Patient starts in standing  Ask them to turn to the left 180 degrees – count number of steps  Ask them to turn to the right 180 degrees – count the number of steps  Ensure you have supporting surfaces around to ensure patient feels secure
  9. 9. Activities of Daily Living Task: Think of a task, activity or hobby you completed yesterday. What did you need to be able to do it?  Physical abilities  Cognitive abilities  Social factors  Environmental factors  Equipment
  10. 10. Functional Assessment in Community Settings  It’s a privilege and a challenge.  Multi-contextual:  Physical  Cognitive  Social  Environmental  PERSONAL  Many of the fundamental functional skills translate to more complex activities of daily living.  Start small. Think BIG.
  11. 11. The problem with assessment… 8 35 88 4 25 44 0 20 40 60 80 100 120 140 Number Frailty Category by Grip Strength (Romero-Ortuno et al. 2010) Female Male ‘Robust’ ‘Pre-Frailty’ ‘Frailty’
  12. 12. Summary  Functional assessment highlights likely limitations for people living with frailty and is our opportunity to reduce their effect, improve outcomes and allow people to live the life they want to live.  It’s the responsibility of ALL clinicians who work with people living with frailty, but refer to physiotherapists and occupational therapists for targeted intervention.
  13. 13. Any Questions/Comments?
  14. 14. References  Coelho, T. et al. (2015) 'Frailty as a predictor of short-term adverse outcomes', PeerJ, 3, pp. e1121-e1121.  Farrell M. (2004) Using functional assessment and screening tools with frail older adults. Topics in geriatric rehabilitation 2004;20(1):14-20.  Romero-Ortuno, R. et al. (2010) 'A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)', BMC Geriatrics, 10, pp. 57-57.  Royal College of Occupational Therapists. (2015) Occupational therapy in the prevention and management of falls in adults: practice guideline. Royal College of Occupational Therapists, Specialist Section Older Adults: London.  Simpson J, Worsford C (1996) ‘Simple test of balance for frail old people’(abstract from proceedings of the Society for Research in Rehabilitation held at the Royal Hospital for Neurodisability, Putney, UK, Jan11 1996 (Clinical Rehabilitation 10 :354)  Trevisan, C. et al. (2017) 'Factors influencing transitions between frailty states in elderly adults: The Progetto Veneto Anziani Longitudinal Study', Journal of the American Geriatrics Society, 65(1), pp. 179-184.  Woo, J., Leung, J. and Morley, J. (2012) 'Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation', Journal of the American Geriatrics Society, 60(8), pp. 1478-1486.

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