Comprehensive geriatric assessment (CGA) is a multidisciplinary process to assess medical, psychological, and functional limitations in frail older adults to develop a coordinated care plan. It involves a 3-step process of targeting appropriate patients, assessing patients across domains, and implementing recommendations from the multidisciplinary team. Meta-analyses have found CGA to be effective in reducing functional decline, mortality, and nursing home admissions. Key domains assessed include cognition, mood, functional status, nutrition, vision, hearing, continence, social support, medications, and advance care planning.
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up
Ageing is an important physiological phenomenon faced by all living individuals that is multifactorial and complex. The causation is still a matter of controversy. There is a lack of consensus regarding the appropriate age of ageing, though most of the countries uses chronological ages.
This presentation is regarding active ageing that builds up framework that will help the elderly mass to live a disease free active life with active participation and security in life.
This presentation also describes the different challenges faced by the elderly population for active ageing.
Government of India has been working for the aged population and there has been a number of policies and programmes that are solely dedicated to the elderly masses that has been also described here.
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up
Ageing is an important physiological phenomenon faced by all living individuals that is multifactorial and complex. The causation is still a matter of controversy. There is a lack of consensus regarding the appropriate age of ageing, though most of the countries uses chronological ages.
This presentation is regarding active ageing that builds up framework that will help the elderly mass to live a disease free active life with active participation and security in life.
This presentation also describes the different challenges faced by the elderly population for active ageing.
Government of India has been working for the aged population and there has been a number of policies and programmes that are solely dedicated to the elderly masses that has been also described here.
Geriatrics is a sub-specialty of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.
Health promotion is the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being.
Mental health issues such as depression and anxiety are NOT a normal part of aging and are hard to discuss, diagnose and treat. The good news is that there are innovative programs, tools and resources that can help.
Geriatrics is a sub-specialty of medicine that focuses on health care of the elderly. It aims to promote health and to prevent and treat diseases and disabilities in older adults.
Health promotion is the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being.
Mental health issues such as depression and anxiety are NOT a normal part of aging and are hard to discuss, diagnose and treat. The good news is that there are innovative programs, tools and resources that can help.
Review of health literacy: analyzed a total of 7 meta-analyses, 7 randomized control trials, 11 retrospective cohorts and 9 cross-sectional surveys. These slides include the findings and conclusions from the strongest evidence.
June 1, 2018
Historically and across societies people with disabilities have been stigmatized and excluded from social opportunities on a variety of culturally specific grounds. These justifications include assertions that people with disabilities are biologically defective, less than capable, costly, suffering, or fundamentally inappropriate for social inclusion. Rethinking the idea of disability so as to detach being disabled from inescapable disadvantage has been considered a key to twenty-first century reconstruction of how disablement is best understood.
Such ‘destigmatizing’ has prompted hot contestation about disability. Bioethicists in the ‘destigmatizing’ camp have lined up to present non-normative accounts, ranging from modest to audacious, that characterize disablement as “mere difference” or in other neutral terms. The arguments for their approach range from applications of standards for epistemic justice to insights provided by evolutionary biology. Conversely, other bioethicists vehemently reject such non-normative or “mere difference” accounts, arguing instead for a “bad difference” stance. “Bad difference” proponents contend that our strongest intuitions make us weigh disability negatively. Furthermore, they warn, destigmatizing disability could be dangerous because social support for medical programs that prevent or cure disability is predicated on disability’s being a condition that it is rational to avoid. Construing disability as normatively neutral thus could undermine the premises for resource support, access priorities, and cultural mores on which the practice of medicine depends.
The “mere difference” vs. “bad difference” debate can have serious implications for legal and policy treatment of disability, and shape strategies for allocating and accessing health care. For example, the framing of disability impacts the implementation of the Americans with Disabilities Act, Section 1557 of the Affordable Care Act, and other legal tools designed to address discrimination. The characterization of disability also has health care allocation and accessibility ramifications, such as the treatment of preexisting condition preclusions in health insurance. The aim of this conference was to construct a twenty-first century conception of disablement that resolves the tension about whether being disabled is merely neutral or must be bad, examines and articulates the clinical, philosophical, and practical implications of that determination, and attempts to integrate these conclusions into medical and legal practices.
Learn more: http://petrieflom.law.harvard.edu/events/details/2018-petrie-flom-center-annual-conference
Determinants of health refer to the various factors that influence an individual's overall health status.
Dimensions of health, on the other hand, represent different aspects or components of health. I
Patient Directed Care; Why it’s important and what does it really mean?Spectrum Health System
Understanding the importance of effective patient centered communication for patient engagement and improved health outcomes. Will discuss the importance of patient directed care and its relationship to the quadruple aim. Will discuss the barriers and a framework for conversations that are critical to patient directed care and cultural competency.
1 Grace Christ, DSW—Columbia University, School of Social.docxoswald1horne84988
1
*Grace Christ, DSW—Columbia University, School of Social Work
Sadhna Diwan, PhD—San Jose State University, School of Social Work
CHRONIC ILLNESS AND AGING
SECTION 2: THE ROLE OF SOCIAL WORK
IN MANAGING CHRONIC ILLNESS CARE
Grace Christ and Sadhna Diwan*
Synopsis
Managing chronic illness presents a profound challenge to the social work
profession, not only because of the myriad formal and informal services required by the
increasing number of chronically ill elders, but also because the caregivers, too, require
our support and empowerment. As professionals, social workers experience first‐hand
the effects of the met and unmet patient needs, which brings with it a responsibility to
insure that practice and policy decisions give full recognition to the impact of
psychosocial aspects and services that provide total care to chronically ill older adults
and their caregivers.
This section describes some of the most recent literature addressing the role of
social workers in managing chronic illness care specifically related to conducting
biopsychosocial assessments, providing interventions, and in designing and
implementing effective models of health services delivery such as care coordination.
Characteristics of Chronic Illness
as They Impact the Social Work Role
Three important characteristics of chronic illnesses among older adults need to be considered
as they affect the social work role and function.
1. The trajectory for many serious illnesses has changed from an acute terminal
course to a much longer chronic period, with episodes of exacerbations and
remissions interspersed with extended periods of good functioning.
2. The trajectory of advanced chronic and terminal illnesses has changed from a
relatively brief period to a longer period in which both curative and
palliative treatments are combined. Research suggests that a long, advanced
chronic illness can be highly stressful for both patients and their families.
Christ & Diwan Chronic Illness—Role of Social Work
3. The increase in the total number of older people with advanced chronic and
terminal illnesses will require more curative and palliative care being
provided in the home, with greater reliance on provision by family members.
Advances in medical care have changed the illness trajectory in ways that
dramatically alter the older adult’s experience of chronic illness. Facilitating and
enhancing positive health behaviors at all stages of life as well as effective management
of chronic illness is central to the social worker’s role, knowledge, value, and skill base
in health care.
The specific role of social workers in health care is to address psychological,
behavioral, and social factors by (1) assessing patient and family psychosocial health
needs, (2) providing interventions required to address their psychosocial needs and
promote their adaptation to illness and disability, and (3) developing and implementing
effecti.
1 Grace Christ, DSW—Columbia University, School of Social.docxhoney725342
1
*Grace Christ, DSW—Columbia University, School of Social Work
Sadhna Diwan, PhD—San Jose State University, School of Social Work
CHRONIC ILLNESS AND AGING
SECTION 2: THE ROLE OF SOCIAL WORK
IN MANAGING CHRONIC ILLNESS CARE
Grace Christ and Sadhna Diwan*
Synopsis
Managing chronic illness presents a profound challenge to the social work
profession, not only because of the myriad formal and informal services required by the
increasing number of chronically ill elders, but also because the caregivers, too, require
our support and empowerment. As professionals, social workers experience first‐hand
the effects of the met and unmet patient needs, which brings with it a responsibility to
insure that practice and policy decisions give full recognition to the impact of
psychosocial aspects and services that provide total care to chronically ill older adults
and their caregivers.
This section describes some of the most recent literature addressing the role of
social workers in managing chronic illness care specifically related to conducting
biopsychosocial assessments, providing interventions, and in designing and
implementing effective models of health services delivery such as care coordination.
Characteristics of Chronic Illness
as They Impact the Social Work Role
Three important characteristics of chronic illnesses among older adults need to be considered
as they affect the social work role and function.
1. The trajectory for many serious illnesses has changed from an acute terminal
course to a much longer chronic period, with episodes of exacerbations and
remissions interspersed with extended periods of good functioning.
2. The trajectory of advanced chronic and terminal illnesses has changed from a
relatively brief period to a longer period in which both curative and
palliative treatments are combined. Research suggests that a long, advanced
chronic illness can be highly stressful for both patients and their families.
Christ & Diwan Chronic Illness—Role of Social Work
3. The increase in the total number of older people with advanced chronic and
terminal illnesses will require more curative and palliative care being
provided in the home, with greater reliance on provision by family members.
Advances in medical care have changed the illness trajectory in ways that
dramatically alter the older adult’s experience of chronic illness. Facilitating and
enhancing positive health behaviors at all stages of life as well as effective management
of chronic illness is central to the social worker’s role, knowledge, value, and skill base
in health care.
The specific role of social workers in health care is to address psychological,
behavioral, and social factors by (1) assessing patient and family psychosocial health
needs, (2) providing interventions required to address their psychosocial needs and
promote their adaptation to illness and disability, and (3) developing and implementing
effecti ...
Caring for all in the last year of life: making a difference.Bruce Mason
Inaugural presentation by Prof. Scott A. Murray, St Columba's Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group, Centre for Population Health Sciences: General Practice Section, University of Edinburgh. April 21, 2009
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
4. What is CGA???
A multidisciplinary
diagnostic and treatment process that identifies
medical, psychosocial, and functional limitations
of a frail older person in order to develop
a coordinated plan to
maximize overall health
with aging
6. AIM
Restoration of health function
Independence where possible
Amelioration of disability and distress
7. Multi-disciplinary team
Family doctor
Nurses
Speech therapist
Dietician
Physiotherapist
Occupational therapist
Pharmacist
Community
supportFamily
Geriatrician
Multi-disciplinary team
Psychologist
Social worker
8. Target population
• Age
• Multiple medical co morbidities eg: heart
failure, cancer
• Psychosocial disorder : depression, isolation
• Specific geriatric conditions : dementia, falls,
functional disability
9. Target population
• Previous or predicted high health care
utilisation
• Considering of change in living situation
from independent living to assisted, nursing
home or in home care givers
10. Target population
• Too Sick to Benefit
: Critically ill or medically unstable
: Terminally ill
: Disorders with no effective treatment
• Too Well to Benefit
: One or a few medical conditions
: Needing prevention measures only
11. Target population
• Appropriate and Will Benefit
: Multiple interacting biopsychological problems
that are amenable to treatment
: Disorders that require rehabilitation therapy
12. FRAME WORK
1) Data-gathering
2) Discussion among the team, increasingly
including the patient and/or caregiver as a
member of the team
3) Development, with the patient and/or caregiver,
of a treatment plan
4) Implementation of the treatment plan
5) Monitoring response to the treatment plan
6) Revising the treatment plan
15. Efficacy
• Multiple meta-analyses have found home
assessments to be consistently effective in
reducing functional decline as well as overall
mortality
1. Stuck AE, Egger M, Hammer A, et al. Home visits to prevent nursing home admission and functional decline in elderly
people: systematic review and meta-regression analysis. JAMA 2002; 287:1022.
2. Elkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: systematic review and
meta-analysis. BMJ 2001; 323:719.
3. Huss A, Stuck AE, Rubenstein LZ, et al. Multidimensional preventive home visit programs for community-dwelling
older adults: a systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci 2008;
63:298.
Stuck AE, Siu AL, Wieland GD, et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet
1993; 342:1032.
16. • 17 randomized trials evaluating geriatric
rehabilitative units (within an acute care
hospital or a rehabilitation hospital) found that
inpatient multidisciplinary programs were
associated with improvement in all outcomes
at discharge, including better functional status
(OR 1.75, 95% CI 1.31-2.35), decreased nursing
home admission (relative risk [RR] 0.64, 0.51-
0.81), and reduced mortality (RR 0.72, 0.55-
0.95).
Bachmann S, Finger C, Huss A, et al. Inpatient rehabilitation specifically designed for geriatric patients:
systematic review and meta-analysis of randomised controlled trials. BMJ 2010; 340:c1718.
17. • A meta-analysis of 22 randomized trials of
inpatient CGA by mobile teams or in
designated wards found that patients who
received CGA were more likely to be alive and
in their own homes at the end of the
scheduled follow-up (OR 1.1, 95% CI 1.05-
1.28) and less likely to be living in residential
care (OR 0.78, 95% CI 0.69-0.88), compared
with usual care
Ellis G, Whitehead MA, Robinson D, et al. Comprehensive geriatric assessment for older adults
admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011; 343:d6553.
23. Functional domain
Advanced Activities of Daily Living
Ability to fulfill societal, community and
family roles and participate in recreational or
occupational tasks
24. • Data from: Saliba D, Elliott M, Rubenstein LZ, et al. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in
the community. J Am Geriatr Soc 2001; 49:1691.
25. FALLS/ IMBALANCE
Approximately
1/3rd community-dwelling persons age 65 years
1/2 of those over 80 years of age fall/year.
1/5th of the elderly in Ernakulam fall/year.
higher risk of having a subsequent fall and
losing independence
26. Screening for fall/ risk for falling
• History of falls in prior 12 months
• Presents with acute fall
• Difficulty with walking or balance
.
The Prevention of Falls in Older Persons: Clinical Practice Guideline(http://www.medcats.com/FALLS/frameset.htm)
from the American Geriatrics Society. For more information visit the AGS online at www.americangeriatrics.org
27.
28. Functional domain
GET UP AND GO TEST:
• Only valid in patients not using an assistive
device
• Get up and walk 10ft, and return to chair
Seconds Rating
<10 freely mobile
<20 mostly independent
20-29 variable mobility
>30 assisted mobility
29. Functional domain
• Sensitivity 88%
• Specificity 94%
• Time to complete <1 minute
• Requires no special equipment
Cassel, C. Geriatric Medicine: An Evidence-Based Approach, 4th edition, Instruments
to Assess Functional Status, p. 186.
30. Gait Speed
• Gait speed alone predicts functional decline
and early mortality in older adults
• Eg. elevated blood pressure in individuals age
≥ 65yrs was associated with increased
mortality only in individuals with a walking
speed ≥0.8 meters/second (measured over 6
meters or 20 feet)
1. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA 2011; 305:50.
2. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in
elderly adults: the impact of frailty. Arch Intern Med 2012; 172:1162.
45. NEWER APPLICATIONS OF CGA
• cancer patients undergoing chemotherapy [1]
• considerations of surgery, or transcatheter
aortic valve replacement for patients with
aortic stenosis [2]
• postoperative mortality risk [3].
1. Kalsi T, Babic-Illman G, Ross PJ, et al. The impact of comprehensive geriatric assessment interventions on tolerance to
chemotherapy in older people. Br J Cancer 2015; 112:1435.
2. Boureau AS, Trochu JN, Colliard C, et al. Determinants in treatment decision-making in older patients with symptomatic
severe aortic stenosis. Maturitas 2015; 82:128.
3. Kim SW, Han HS, Jung HW, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA
Surg 2014; 149:633.
46. Conclusion
• Multi disciplinary approach
• Targeted population
• High efficacy
• Can be brought to practice easily
• Essential part of geriatric care
Editor's Notes
Pre admission and discharge ADL’s of pts with functional decline during index hospitalisation
One measure of independence is the capacity to perform functional tasks
Necessary for daily living.
Katz’s ADL’s----developed in the 1960’s. Measuring six functions,each noted
either as independent or dependent
Initially used by a professional (nurse in an inpt setting) based on observations
over a week
Since then, many modifications
Mnemonic---- “DEATH” --- a way to help you remember the activities
Evaluated--- D= dressing, E=eating, A=ambulating, T= toileting, H=hygiene
Labor saving equipment may change laundry from an impossiblity to a
manageable task
Some men who can not prepare meals may simply not know how to cook
Instrumental (community interactions)--- mnemonic “SHAFT”
S=shopping, 2.H=housework, 3. A=Accounting, 4. F=food preparation and
5. T=transportation
In JAGS 1999 community dwelling more tan 65 years, followed up at 1 yr, 3 yr, 5 yr . 4 modalities – telephone, transportation, medication, finance
At 3 years, IADL impairment is a predicator of incident dementia
