Functional Decline

Functional decline represents a change in a patient's ability to perform tasks of independent living and is not a part of normal aging. This can be assessed with the use of a standard scale for Activities of Daily Living (ADL), which evaluates a patient's ability for bathing, dressing, toileting, transferring (in or out of a bed or chair), continence, and feeding (T.a.ble 300:.2.).18 The patient is asked whether he or she can perform each of these functions with no assistance, with partial assistance, or cannot perform these functions. If a patient cannot perform these basic activities of daily living, then a caregiver is necessary. Deterioration in ADL generally follows an orderly progressive pattern of bathing, dressing, toileting (including continence), transferring, and feeding. When this pattern is not seen, such as a deterioration in feeding before the others, organ disease should be suspected. Another scale, the Instrumental Activities of Daily Living (IADL), assesses more sophisticated skills, such as telephone use, walking, shopping, preparing meals, housework, handiwork, laundry, taking medicines, and handling finances ( Table. ...3.0.0-3.)■19 It is best to use these formal scales in evaluating older patients and assessing changes over time. Acute functional decline represents an acute medical syndrome that needs appropriate workup and treatment. An algorithm for the ED evaluation of functional decline is presented in Fig 300z42° The differential diagnosis for functional decline includes serious diseases such as myocardial infarction, sepsis, and subdural hematoma, as well as adverse drug reactions. Patients will often present with a vague symptom, such as weakness, that on further questioning and use of the scale is noted to be functional decline.

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