A Key Indicator
Functional decline is not thoroughly investigated in busy physician practices, where the focus is on rapid management of the presenting problem. But it is becoming more important as Medicare beneficiaries, who will number 80 million by 2030, are living longer with multiple chronic conditions. They are turning to hospitals and EDs when they experience clinical and functional decline.
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Functional decline proves to be a key indicator of disease progression and appropriateness for hospice and palliative services in elderly patients with chronic illness and multi-morbidity.
An article published in Annals of Family Medicine, “Functional Trajectories in the Year Before Hospice” (January/February 2015), measured elderly patients’ need for assistance in these activities: bathing, dressing, walking, transferring, shopping, doing housework, preparing meals, taking medications, managing finances, walking a quarter mile, climbing a flight of stairs and lifting/carrying ten pounds.
The ED is the first place elderly patients with chronic illness and multi-morbidity turn for support. Rapid assessment of functional status can be ascertained by assessing the patient’s need for assistance in the above activities six months ago, three months ago and now. Armed with this information, ED physicians can make appropriate hospice referrals. Patients and families can maximize the benefits of palliative services and have an interdisciplinary team help manage advanced illness at home. And ED overuse in the population can be addressed.