Older home health care patients and their physicians: assessment of functional ability

Assessment of a person's level of functional impairment is a key aspect of geriatric clinical practice. This study examines the agreement between functional assessments reported by 54 physician-patient dyads. Physicians were typical of those providing services to elderly patients in an urban area. Patients, all aged 65 or more years and community-living, had been referred by these physicians for in-home health care services. Generally, physicians reported less impairment than did their patients, functional assessments by both doctors and patients matching completely in only 15 of 54 (28%) dyads. Underestimation of patient impairment occurred most commonly with respect to stair climbing, control of the urinary bladder, and bathing, but was also substantial for dressing, walking, and toileting. Few patient or doctor characteristics predicted congruence or lack thereof in assessment of functional impairments. Some implications of these findings for clinical practice and medical education are examined.