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Impairment Evaluation
Aka: Impairment Evaluation, Geriatric Functional Screening, Functional Decline in Older Adults
- See Also
- Disability
- Disability Evaluation
- Disability Management
- Functional Capacity Evaluation
- Assistive Technology
- Letter of Medical Necessity
- Disability Referral
- Activities of Daily Living
- Failure to Thrive in the Elderly
- Elderly Drivers with Cognitive Impairment
- Medication Use in the Elderly (Beers List, STOPP)
- Approach
- Determine third party requesting the evaluation
- Examples: Employer, insurer, judge, family
- Determine nature of the request
- Examples: Diagnosis, cause, treatment, work capacity, disposition
- Determine physician's role
- Examples: Second opinion, independent medical examiner, facilitator
- Identify specific medical Impairments (condition diagnoses)
- Diagnoses and severity
- Overall functional impact
- Characterize the Disability (Impairments precluding specific tasks)
- Time course (gradual or rapid)
- Associated symptoms
- Specific activities affected
- Compensatory measures
- History
- Comorbidity
- Cardiopulmonary disease (e.g. CAD, CHF, COPD)
- Musculoskeletal Conditions (e.g. Rheumatoid Arthritis, Osteoarthritis, Spinal stenosis)
- Mood Disorders (e.g. Schizophrenia, Bipolar Disorder, Severe Major Depression)
- Cognitive disorders (e.g. Dementia)
- Neurologic conditions (e.g. Cerebrovascular Accident, Seizure Disorder)
- Endocrine conditions (e.g. Diabetes Mellitus)
- Hematologic conditions (e.g. Anemia)
- Sensory deficits
- Hearing Impairment
- Visual Impairment
- Cognitive and perceptual history
- Addiction
- Planning
- Conscientiousness, honesty and trustworthiness
- Interpersonal functioning
- Motivation and Reliability
- Pace, persistence and stress tolerance
- Mood
- Pain
- Activities of Daily Living (ADL)
- Katz ADL Scale
- Barthel Index
- Ambulation and Transfers
- Bathing and Toileting
- Dressing and Grooming
- Eating
- See Geriatric Nutrition Checklist
- Instrumental Activities of Daily Living (IADL)
- Shopping
- Transportation
- Telephone
- Managing money and medication
- Cleaning house
- Cooking
- Mobility
- Balance and coordination
- Strength and endurance
- Stair climbing
- Environment
- Home (Family factors and expectations)
- See Caregiver Burden Scale
- Work or School
- Community
- Resources
- Communication
- Vocational status
- Work training and experience
- Opportunities
- Financial status
- Educational status
- Recreational needs
- Transportation needs
- Community interaction
- Social support (e.g. family or friends in time of emergency)
- Examination
- Cognition and mental status
- See Mental Status Exam
- Time and Change Test
- Six Item Cognitive Impairment Test (6CIT)
- Blessed Orientation Memory Concentration (BOMC)
- Copland's Short-Test of Mental Status
- Short Test of Mental Status (STMS)
- Blessed Information Memory Concentration (BIMC)
- Saint Louis University Mental Status (SLUMS)
- Mood and Affect
- See Depression Screening Tools
- Patient Health Questionaire 9 (PHQ-9)
- Geriatric Depression Scale
- Sensory
- Vision
- See Vision Screening
- Near: Read newsprint or a child's book (11 to 12 point type)
- Far: Snellen Chart
- Hearing
- See Hearing Testing
- Whisper test
- Audioscope or Audiogram
- Special senses
- Proprioception
- Vibration sense
- Temperature sense
- Functional Range of Motion
- Shoulder Range of Motion
- Hands clasped behind head
- Hands clasped behind back
- Hip and knee raneg of motion
- Place ankle on opposite knee
- Back range of motion
- Touch toes while sitting
- Coordination, Gait and Balance
- Gentle nudge to Sternum (while patient is standing)
- Romberg Test
- Tinetti balance Test
- Gait evaluation Scale
- Motor Strength and Functional Testing
- Squeeze or grip two fingers
- Pinch paper
- "Get up and go" test (Mobility, agility, and aerobic capacity)
- Get up from floor
- Chair Stand Test (rise from chair without using arms)
- Climb stairs
- Pick Up A Penny from the floor
- Functional Independent Measure
- Grading: Severity
- Asymptomatic
- Mild
- Moderate
- Severe
- End-Stage
- Management: Increase capacity
- See Disability Management
- Medication management
- Examples: Supplemental Oxygen for COPD
- Surgery
- Examples: Hip Replacement, Cataract replacement
- Nutrition
- Examples: Consider nutrition supplements
- Prosthetics
- Examples: Hearing Aid
- Exercise
- See Exercise Prescription
- See Exercise in Chronic Pain
- See Exercise in COPD
- See Exercise in Diabetes Mellitus
- See Exercise in Obesity
- See Exercise in Osteoporosis
- See Exercise in Patients with Arthritis
- See Exercise in the Elderly
- See Exercise Participation in Hypertensive Patients
- Management: Decrease Task Demand
- Environmental modification
- See No-fail Environment in Dementia
- See Home Adaptations for the Elderly
- See Fall Prevention
- Assistive Devices
- See Assistive Technology
- See Ambulatory Assistive Device
- Human Resources
- Home Health Aids
- Assisted Living
- Adaptive Training
- Energy conservation
- References
- (1997) Can Med Assoc J 156:680A-C [PubMed]
- Barron (2001) Am Fam Physician 64(9): 1579-86 [PubMed]
- Colon-Emeric (2013) Am Fam Physician 88(6): 388-394 [PubMed]
- Derebry (1983) J Occup Med 25:829-35 [PubMed]
- McGrail (2001) Am Fam Physician 63(4):679-84 [PubMed]