Tools that assess functional decline: systematic literature review update

Screening for risk of functional decline in the elderly is increasingly important in ambulatory health care settings, to ensure that appropriate services are provided to reduce the risk of downstream decline. These screening tools should have sound psychometric properties and clinical utility.

An updated systematic literature review for (1) new screening tools published since the last review, conducted in 2007 and published in 2008, and (2) recent research into psychometric properties of the five tools identified in the previous review.

A comprehensive review of multiple databases using the search terms from the Sutton et al review was conducted. The reference lists of included articles were hand-searched for additional articles, and the literature was evaluated with the appropriate critical appraisal tool. Included screening tools should be designed for, or applicable to, hospital emergency departments.

Two relevant new tools were identified (the Simplified PROFUNCTION index and Brief Risk Identification for Geriatric Health Tool). Six additional papers testing psychometric properties of four of the five previously reported screening tools were also found.

Seven relevant screening tools are available with similar validity and reliability estimates. They consider similar constructs and have convincing evidence of applicability to a range of older populations, or different cultures. Identification of Seniors at Risk, is the most frequently reported screening tool. The wider unanswered question is how, why, and where these functional decline screening tools are used; how valid the findings are on ill, stressed, older people in emergency departments; and how the findings are acted upon in terms of community intervention to slow functional decline.