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  • Guideline Summary
  • NGC:009706
  • 2003 (revised 2012)

Assessment of physical function. In: Evidence-based geriatric nursing protocols for best practice.

Kresevic DM. Assessment of physical function. In: Boltz M, Capezuti E, Fulmer T, Zwicker D, editor(s). Evidence-based geriatric nursing protocols for best practice. 4th ed. New York (NY): Springer Publishing Company; 2012. p. 89-103.

View the original guideline documentation External Web Site Policy

This is the current release of the guideline.

This guideline updates a previous version: Kresevic DM. Assessment of function. In: Capezuti E, Zwicker D, Mezey M, Fulmer T, editor(s). Evidence-based geriatric nursing protocols for best practice. 3rd ed. New York (NY): Springer Publishing Company; 2008 Jan. p. 23-40.

Age Group

UMLS Concepts (what is this?)

SNOMEDCT_US
Activities of daily living assessment (304492001), Activity of daily living (129025006), Assistive equipment (360296002), Bed rest care management (385886008), Bedrest (225316001), Care of the elderly nurse (224545006), Caregiver support (386229000), Community health services (413294000), Education of caregiver (427519008), Education of caregiver (460617003), Environment (276339004), Exercise (183301007), Exercise (256235009), Exercise (61686008), Functional assessment (12894003), Functional disorder (386585008), Geriatric screening (171313004), Inpatient care (394656005), Instrumental activities of daily living (273534002), Katz activities of daily living (273547007), Mobility screening (171301009), Occupational therapy (84478008), Pain (22253000), Pain management (278414003), Patient education (311401005), Physical handicap (32572006), Physical restraint (386423001), Physical therapy procedure (91251008), Regular daily routine (225788005)

Major Recommendations

Levels of evidence (I–VI) are defined at the end of the "Major Recommendations" field.

Assessment Parameters

  • Comprehensive functional assessment of older adults includes independent performance of basic activities of daily living (ADLs), social activities, or instrumental activities of daily living (IADLs), the assistance needed to accomplish these tasks, and the sensory ability, cognition, and capacity to ambulate (Campbell et al., 2004 [Level I]; Doran et al., 2006 [Level VI]; Freedman, Martin, & Schoeni, 2002 [Level I]; Kane & Kane, 2000 [Level VI]; Katz et al., 1963 [Level I]; Lawton & Brody, 1969 [Level IV]; Lightbody & Baldwin, 2002 [Level VI]; McCusker, Kakuma, & Abrahamowicz, 2002 [Level I]; Tinetti & Ginter, 1988 [Level I]).
    • Basic ADLs (bathing, dressing, grooming, eating, continence, transferring)
    • IADLs (meal preparation, shopping, medication administration, housework, transportation, accounting)
    • Mobility (ambulation, pivoting)
  • Older adults may view their health in terms of how well they can function rather than in terms of disease alone. Strengths should be emphasized as well as needs for assistance (Depp & Jeste, 2006 [Level I]; Pearson, 2000 [Level VI]).
  • The clinician should document baseline functional status and recent or progressive declines in function (Graf, 2006 [Level V]).
  • Function should be assessed over time to validate capacity, decline, or progress (Applegate, Blass, & Franklin, 1990 [Level IV]; Callahan et al., 2002 [Level VI]; Kane & Kane, 2000 [Level VI]).
  • Standard instruments selected to assess function should be efficient to administer and easy to interpret. They should provide useful practical information for clinicians and should be incorporated into routine history taking and daily assessments (Kane & Kane, 2000 [Level VI]; Kresevic et al., 1998 [Level VI]) (see the "Availability of Companion Documents" field for tools).
  • Interdisciplinary communication regarding functional status, changes, and expected trajectory should be part of all care settings and should include the patient and family whenever possible (Counsell et al., 2000 [Level II]; Covinsky et al., 1998 [Level II]; Kresevic et al., 1998 [Level VI]; Landefeld et al., 1995 [Level II]).

Care Strategies

Strategies to Maximize Functional Status and to Prevent Decline

  • Maintain individual's daily routine. Help to maintain physical, cognitive, and social function through physical activity and socialization. Encourage ambulation, allow flexible visitation including pets, and encourage reading the newspaper (Kresevic & Holder, 1998 [Level VI]; Landefeld et al., 1995 [Level II]).
  • Educate older adults, family, and formal caregivers on the value of independent functioning and the consequences of functional decline (Graf, 2006 [Level V]; Kresevic & Holder, 1998 [Level VI]; Vass et al., 2005 [Level II]).
    • Physiological and psychological value of independent functioning.
    • Reversible functional decline associated with acute illness (Hirsch, 1990 [Level IV]; Sager & Rudberg, 1998 [Level II]).
    • Strategies to prevent functional decline: exercise, nutrition, pain management, and socialization (Kresevic & Holder 1998 [Level VI]; Landefeld et al., 1995 [Level II]; Siegler, Glick, & Lee, 2002 [Level VI]; Tucker, Molsberger, & Clark, 2004 [Level VI]).
    • Sources of assistance to manage decline.
  • Encourage activity including routine exercise, range of motion, and ambulation to maintain activity, flexibility, and function (Counsell et al., 2000 [Level II]; Landefeld et al., 1995 [Level II]; Pedersen & Saltin, 2006 [Level I]).
  • Minimize bed rest (Bates-Jensen et al., 2004 [Level V]; Covinsky et al., 1998 [Level II]; Kresevic & Holder, 1998 [Level VI]; Landefeld et al., 1995 [Level II]).
  • Explore alternatives to physical restraints use (see the National Guideline Clearinghouse [NGC] summary of the Hartford Institute for Geriatric Nursing guideline Physical restraints and side rails in acute and critical care settings) (Kresevic & Holder, 1998 [Level VI]; Covinsky et al., 1998 [Level II]).
  • Judiciously use medications, especially psychoactive medications, in geriatric dosages (see the NGC summary of the Hartford Institute for Geriatric Nursing guideline Reducing adverse drug events in older adults) (Inouye et al., 1998 [Level III]).
  • Assess and treat for pain (Covinsky et al., 1998 [Level II]).
  • Design environments with handrails, wide doorways, raised toilet seats, shower seats, enhanced lighting, low beds, and chairs of various types and height (Cunningham & Michael, 2004 [Level I]; Kresevic & Holder, 1998 [Level VI]).
  • Help individuals regain baseline function after acute illnesses by using exercise, physical or occupational therapy consultation, nutrition, and coaching (Conn et al., 2003 [Level I]; Covinsky et al., 1998 [Level II]; Engberg et al., 2002 [Level II]; Forbes, 2005 [Level VI]; Hodgkinson, Evans, & Wood, 2003 [Level I]; Kresevic et al., 1998 [Level VI]).

Strategies to Help Older Individuals Cope with Functional Decline

  • Help older adults and family members determine realistic functional capacity with interdisciplinary consultation (Kresevic & Holder, 1998 [Level VI]).
  • Provide caregiver education and support for families of individuals when decline cannot be ameliorated in spite of nursing and rehabilitative efforts (Graf, 2006 [Level V]).
  • Carefully document all intervention strategies and patient responses (Graf, 2006 [Level V]).
  • Provide information to caregivers on causes of functional decline related to acute and chronic conditions (Covinsky et al., 1998 [Level II]).
  • Provide education to address safety care needs for falls, injuries, and common complications. Short-term skilled care for physical therapy may be needed; long-term care settings may be required to ensure safety (Covinsky et al., 1998 [Level II]).
  • Provide sufficient protein and caloric intake to ensure adequate intake and prevent further decline. Liberalize diet to include personal preferences (Edington et al., 2004 [Level II]; Landefeld et al., 1995 [Level II]).
  • Provide caregiver support and community services, such as home care, nursing, and physical and occupational therapy services to manage functional decline (Covinsky et al., 1998 [Level II]; Graf, 2006 [Level V]).

Definitions:

Levels of Evidence

Level I: Systematic reviews (integrative/meta-analyses/clinical practice guidelines based on systematic reviews)

Level II: Single experimental study (randomized controlled trials [RCTs])

Level III: Quasi-experimental studies

Level IV: Non-experimental studies

Level V: Care report/program evaluation/narrative literature reviews

Level VI: Opinions of respected authorities/consensus panels

AGREE Next Steps Consortium (2009). Appraisal of guidelines for research & evaluation II. Retrieved from http://www.agreetrust.org/?o=1397 External Web Site Policy.

Adapted from: Melnyck, B. M. & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & health care: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins and Stetler, C.B., Morsi, D., Rucki, S., Broughton, S., Corrigan, B., Fitzgerald, J., et al. (1998). Utilization-focused integrative reviews in a nursing service. Applied Nursing Research, 11(4) 195-206.

Clinical Algorithm(s)

None provided

Disease/Condition(s)

Functional decline

Guideline Category

Evaluation

Management

Risk Assessment

Clinical Specialty

Family Practice

Geriatrics

Internal Medicine

Nursing

Intended Users

Advanced Practice Nurses

Allied Health Personnel

Health Care Providers

Nurses

Occupational Therapists

Physical Therapists

Physician Assistants

Physicians

Guideline Objective(s)

To provide a standard of practice protocol to maximize physical functioning, prevent or minimize decline in activities of daily living (ADL) function, and plan for transitions of care

Target Population

Hospitalized older adults

Interventions and Practices Considered

Assessment/Evaluation

  1. Comprehensive functional assessment
    • Basic activities of daily living (ADL)
    • Instrumental ADL (IADL)
    • Mobility
  2. Use of standard instruments to assess function

Management

  1. Maximization of function and prevention of decline
    • Maintenance of daily routine
    • Education of elders, family, and formal caregivers
    • Encouraging activity
    • Minimization of bed rest
    • Alternatives to physical restraints
    • Assessment and treatment of pain
    • Environmental design
    • Regaining baseline functional status
    • Physical and occupational therapies
  2. Helping older individuals cope with functional decline
    • Determining realistic functional capacity
    • Caregiver education and support
    • Use of community resources
    • Documentation of interventions
    • Management of protein and caloric intake

Major Outcomes Considered

  • Performance of activities of activities of daily living (ADL)
  • Functional decline
  • Competence in preventive and restorative strategies for function
  • Use of physical restraints
  • Readmission rate
  • Quality of life
  • Morbidity and mortality

Methods Used to Collect/Select the Evidence

Hand-searches of Published Literature (Primary Sources)

Hand-searches of Published Literature (Secondary Sources)

Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

Although the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument (described in Chapter 1 of the original guideline document, Evidence-based Geriatric Nursing Protocols for Best Practice, 4th ed.) was created to critically appraise clinical practice guidelines, the process and criteria can also be applied to the development and evaluation of clinical practice protocols. Thus, the AGREE instrument has been expanded (i.e., AGREE II) for that purpose to standardize the creation and revision of the geriatric nursing practice guidelines.

The Search for Evidence Process

Locating the best evidence in the published research is dependent on framing a focused, searchable clinical question. The PICO format—an acronym for population, intervention (or occurrence or risk factor), comparison (or control), and outcome—can frame an effective literature search. The editors enlisted the assistance of the New York University Health Sciences librarian to ensure a standardized and efficient approach to collecting evidence on clinical topics. A literature search was conducted to find the best available evidence for each clinical question addressed. The results were rated for level of evidence and sent to the respective chapter author(s) to provide possible substantiation for the nursing practice protocol being developed.

In addition to rating each literature citation as to its level of evidence, each citation was given a general classification, coded as "Risks," "Assessment," "Prevention," "Management," "Evaluation/Follow-up," or "Comprehensive." The citations were organized in a searchable database for later retrieval and output to chapter authors. All authors had to review the evidence and decide on its quality and relevance for inclusion in their chapter or protocol. They had the option, of course, to reject or not use the evidence provided as a result of the search or to dispute the applied level of evidence.

Developing a Search Strategy

Development of a search strategy to capture best evidence begins with database selection and translation of search terms into the controlled vocabulary of the database, if possible. In descending order of importance, the three major databases for finding the best primary evidence for most clinical nursing questions are the Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Medline or PubMed. In addition, the PsycINFO database was used to ensure capture of relevant evidence in the psychology and behavioral sciences literature for many of the topics. Synthesis sources such as UpToDate® and British Medical Journal (BMJ) Clinical Evidence and abstract journals such as Evidence Based Nursing supplemented the initial searches. Searching of other specialty databases may have to be warranted depending on the clinical question.

It bears noting that the database architecture can be exploited to limit the search to articles tagged with the publication type "meta-analysis" in Medline or "systematic review" in CINAHL. Filtering by standard age groups such as "65 and over" is another standard categorical limit for narrowing for relevance. A literature search retrieves the initial citations that begin to provide evidence. Appraisal of the initial literature retrieved may lead the searcher to other cited articles, triggering new ideas for expanding or narrowing the literature search with related descriptors or terms in the article abstract.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence

Weighting According to a Rating Scheme (Scheme Given)

Rating Scheme for the Strength of the Evidence

Levels of Evidence

Level I: Systematic reviews (integrative/meta-analyses/clinical practice guidelines based on systematic reviews)

Level II: Single experimental study (randomized controlled trials [RCTs])

Level III: Quasi-experimental studies

Level IV: Non-experimental studies

Level V: Care report/program evaluation/narrative literature reviews

Level VI: Opinions of respected authorities/consensus panels

AGREE Next Steps Consortium (2009). Appraisal of guidelines for research & evaluation II. Retrieved from http://www.agreetrust.org/?o=1397 External Web Site Policy.

Adapted from: Melnyck, B. M. & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & health care: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins and Stetler, C.B., Morsi, D., Rucki, S., Broughton, S., Corrigan, B., Fitzgerald, J., et al. (1998). Utilization-focused integrative reviews in a nursing service. Applied Nursing Research, 11(4) 195-206.

Methods Used to Analyze the Evidence

Review of Published Meta-Analyses

Systematic Review

Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations

Expert Consensus

Description of Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation

External Peer Review

Internal Peer Review

Description of Method of Guideline Validation

Not stated

References Supporting the Recommendations

Applegate WB, Blass JP, Williams TF. Instruments for the functional assessment of older patients. N Engl J Med. 1990 Apr 26;322(17):1207-14. [81 references] PubMed External Web Site Policy

Bates-Jensen BM, Alessi CA, Cadogan M, Levy-Storms L, Jorge J, Yoshii J, Al-Samarrai NR, Schnelle JF. The Minimum Data Set bedfast quality indicator: differences among nursing homes. Nurs Res. 2004 Jul-Aug;53(4):260-72. PubMed External Web Site Policy

Callahan EH, Thomas DC, Goldhirsch SL, Leipzig RM. Geriatric hospital medicine. Med Clin North Am. 2002 Jul;86(4):707-29. [82 references] PubMed External Web Site Policy

Campbell SE, Seymour DG, Primrose WR, ACMEPLUS Project. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing. 2004 Mar;33(2):110-5. [15 references] PubMed External Web Site Policy

Conn VS, Minor MA, Burks KJ, Rantz MJ, Pomeroy SH. Integrative review of physical activity intervention research with aging adults. J Am Geriatr Soc. 2003 Aug;51(8):1159-68. [30 references] PubMed External Web Site Policy

Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, Quinn LM, Allen KR, Covinsky KE, Landefeld CS. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of acute care for elders (ACE) in a community hospital. J Am Geriatr Soc. 2000 Dec;48(12):1572-81. PubMed External Web Site Policy

Covinsky KE, Palmer RM, Kresevic DM, Kahana E, Counsell SR, Fortinsky RH, Landefeld CS. Improving functional outcomes in older patients: lessons from an acute care for elders unit. Jt Comm J Qual Improv. 1998 Feb;24(2):63-76. PubMed External Web Site Policy

Cunningham GO, Michael YL. Concepts guiding the study of the impact of the built environment on physical activity for older adults: a review of the literature. Am J Health Promot. 2004 Jul-Aug;18(6):435-43. [48 references] PubMed External Web Site Policy

Depp CA, Jeste DV. Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry. 2006 Jan;14(1):6-20. PubMed External Web Site Policy

Doran DM, Harrison MB, Laschinger HS, Hirdes JP, Rukholm E, Sidani S, Hall LM, Tourangeau AE. Nursing-sensitive outcomes data collection in acute care and long-term-care settings. Nurs Res. 2006 Mar-Apr;55(2 Suppl):S75-81. PubMed External Web Site Policy

Edington J, Barnes R, Bryan F, Dupree E, Frost G, Hickson M, Lancaster J, Mongia S, Smith J, Torrance A, West R, Pang F, Coles SJ. A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Clin Nutr. 2004 Apr;23(2):195-204. PubMed External Web Site Policy

Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs. 2002 Sep;29(5):252-65. PubMed External Web Site Policy

Forbes DA. An educational programme for primary healthcare providers improved functional ability in older people living in the community. Evid Based Nurs. 2005 Oct;8(4):122. PubMed External Web Site Policy

Freedman VA, Martin LG, Schoeni RF. Recent trends in disability and functioning among older adults in the United States: a systematic review. JAMA. 2002 Dec 25;288(24):3137-46. [50 references] PubMed External Web Site Policy

Graf C. Functional decline in hospitalized older adults. Am J Nurs. 2006 Jan;106(1):58-67, quiz 67-8. [33 references] PubMed External Web Site Policy

Hirsch CH, Sommers L, Olsen A, Mullen L, Winograd CH. The natural history of functional morbidity in hospitalized older patients. J Am Geriatr Soc. 1990 Dec;38(12):1296-303. [15 references] PubMed External Web Site Policy

Hodgkinson B, Evans D, Wood J. Maintaining oral hydration in older adults: a systematic review. Int J Nurs Pract. 2003 Jun;9(3):S19-28. [32 references] PubMed External Web Site Policy

Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998 Apr;13(4):234-42. PubMed External Web Site Policy

Kane RA, Kane RL. Assessing older persons: measures, meaning, and practical applications. New York (NY): Oxford University Press, Inc.; 2000. 542 p.

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963 Sep 21;185:914-9. PubMed External Web Site Policy

Kresevic D, Holder C. Interdisciplinary care. Clin Geriatr Med. 1998 Nov;14(4):787-98. [12 references] PubMed External Web Site Policy

Kresevic DM, Counsell SR, Covinsky K, Palmer R, Landefeld CS, Holder C, Beeler J. A patient-centered model of acute care for elders. Nurs Clin North Am. 1998 Sep;33(3):515-27. [6 references] PubMed External Web Site Policy

Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995 May 18;332(20):1338-44. PubMed External Web Site Policy

Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969 Autumn;9(3):179-86. PubMed External Web Site Policy

Lightbody E, Baldwin R. Inpatient geriatric evaluation and management did not reduce mortality but reduced functional decline. Evid Based Ment Health. 2002 Nov;5(4):109. PubMed External Web Site Policy

McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci. 2002 Sep;57(9):M569-77. [42 references] PubMed External Web Site Policy

Pearson VI. Assessment of function in older adults. In: Kane RI, Kane RA, editor(s). Assessing older persons: measures, meanings and practical applications. New York (NY): Oxford University Press; 2000. p. 17-34.

Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports. 2006 Feb;16(Suppl 1):3-63. [735 references] PubMed External Web Site Policy

Sager MA, Rudberg MA. Functional decline associated with hospitalization for acute illness. Clin Geriatr Med. 1998 Nov;14(4):669-79. PubMed External Web Site Policy

Siegler EL, Glick D, Lee J. Optimal staffing for Acute Care of the Elderly (ACE) units. Geriatr Nurs. 2002 May-Jun;23(3):152-5. PubMed External Web Site Policy

Tinetti ME, Ginter SF. Identifying mobility dysfunctions in elderly patients. Standard neuromuscular examination or direct assessment?. JAMA. 1988 Feb 26;259(8):1190-3. PubMed External Web Site Policy

Tucker D, Molsberger SC, Clark A. Walking for wellness: a collaborative program to maintain mobility in hospitalized older adults. Geriatr Nurs. 2004 Jul-Aug;25(4):242-5. PubMed External Web Site Policy

Vass M, Avlund K, Lauridsen J, Hendriksen C. Feasible model for prevention of functional decline in older people: municipality-randomized, controlled trial. J Am Geriatr Soc. 2005 Apr;53(4):563-8. PubMed External Web Site Policy

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for selected recommendations (see the "Major Recommendations" field).

Potential Benefits

Patients

  • Maintenance of safe level of activities of daily living (ADLs) and ambulation
  • Provision of necessary adaptations to maintain safety and independence including assistive devices and environmental adaptations
  • Attainment of highest quality of life despite functional level

Providers

  • Increased assessment, identification, and management of patients susceptible to or experiencing functional decline. Routine assessment of functional capacity despite level of care
  • Ongoing documentation and communication of capacity, interventions, goals, and outcomes
  • Competence in preventive and restorative strategies for function
  • Competence in assessing safe environments of care that foster safe independent function

Institution

  • System-wide incorporation of functional assessment into routine assessments
  • Reduced incidence and prevalence of functional decline
  • Decreased morbidity and mortality rates associated with functional decline
  • Reduction in the use of physical restraints, prolonged bed rest, Foley catheters
  • Decreased incidence of delirium
  • Increased prevalence of patients who leave hospital with baseline or improved functional status
  • Decreased readmission rate
  • Increased early utilization of rehabilitative services (occupational and physical therapy)
  • Provision of geriatric-sensitive physical care environments that facilitate safe, independent function such as caregiver educational efforts and walking programs
  • Provision of continued interdisciplinary assessments, care planning, and evaluation of care related to function

Potential Harms

Not stated

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools

Chart Documentation/Checklists/Forms

Mobile Device Resources

Resources

For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

IOM Care Need

Getting Better

Living with Illness

Staying Healthy

IOM Domain

Effectiveness

Patient-centeredness

Bibliographic Source(s)

Kresevic DM. Assessment of physical function. In: Boltz M, Capezuti E, Fulmer T, Zwicker D, editor(s). Evidence-based geriatric nursing protocols for best practice. 4th ed. New York (NY): Springer Publishing Company; 2012. p. 89-103.

Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released

2003 (revised 2012)

Guideline Developer(s)

Hartford Institute for Geriatric Nursing - Academic Institution

Guideline Developer Comment

The guidelines were developed by a group of nursing experts from across the country as part of the Nurses Improving Care for Health System Elders (NICHE) project, under sponsorship of the Hartford Institute for Geriatric Nursing, New York University College of Nursing.

Source(s) of Funding

Hartford Institute for Geriatric Nursing

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Primary Authors: Denise Kresevic, RN, PhD, GNP-BC, GCNS-BC, Nurse Researcher, Louis Stokes Cleveland VAMC, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Kresevic DM. Assessment of function. In: Capezuti E, Zwicker D, Mezey M, Fulmer T, editor(s). Evidence-based geriatric nursing protocols for best practice. 3rd ed. New York (NY): Springer Publishing Company; 2008 Jan. p. 23-40.

Guideline Availability

Electronic copies: Available from the Hartford Institute for Geriatric Nursing Web site External Web Site Policy.

Copies of the book Evidence-Based Geriatric Nursing Protocols for Best Practice, 4th edition: Available from Springer Publishing Company, 536 Broadway, New York, NY 10012; Phone: (212) 431-4370; Fax: (212) 941-7842; Web: www.springerpub.com External Web Site Policy.

Availability of Companion Documents

The following are available:

  • Try This® - issue 2: Katz Index of Independence in Activities of Daily Living (ADL). New York (NY): Hartford Institute for Geriatric Nursing; 2 p. 2012. Electronic copies: Available in Portable Document Format (PDF) at the Hartford Institute for Geriatric Nursing Web site External Web Site Policy.
  • Try This® - issue 23: The Lawton Instrumental Activities of Daily Living (IADL) Scale. New York (NY): Hartford Institute for Geriatric Nursing; 2 p. 2013. Electronic copies: Available in PDF from the Hartford Institute for Geriatric Nursing Web site External Web Site Policy.
  • Try This® - issue 31: Reducing functional decline in older adults during hospitalization: a best practices approach. New York (NY): Hartford Institute for Geriatric Nursing; 2 p. 2012. Electronic copies: Available in PDF at the Hartford Institute for Geriatric Nursing Web site External Web Site Policy.

The ConsultGeriRN app for mobile devices is available through the Hartford Institute for Geriatric Nursing Web site External Web Site Policy.

Patient Resources

None available

NGC Status

This summary was completed by ECRI on May 30, 2003. The information was verified by the guideline developer on August 25, 2003. This guideline was updated by ECRI Institute on June 18, 2008. The updated information was verified by the guideline developer on August 4, 2008. This NGC summary was updated by ECRI Institute on June 24, 2013. The updated information was verified by the guideline developer on August 6, 2013.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

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