Identifying functional decline: a methodological challenge

Functional decline (FD) in older people has commonly been measured in the hospital setting with instruments which have been validated on decrease over time in capacity to undertake basic activities of daily living (ADL). In a nonhospitalized sample of older people (independently community dwelling, but potentially on the cusp of FD), it is possible that other measures could be used to predict decline. Early, accurate, and efficient identification of older community-dwelling people who are on the cusp of FD can assist in identifying appropriate interventions to slow the rate of decline.

This paper reports on associations between four outcome measures which have been associated with FD (instrumental ADLs [IADLs], quality of life, hospitalizations and falls). The sample was older individuals who were discharged from one large metropolitan emergency department (ED) during 2011-2012, without an inpatient admission.

Of 597 individuals aged 65+ who provided baseline information, 148 subjects provided four outcome measures at both 1 and 3 months follow up. Overall, approximately 24% demonstrated decreased IADL scores over the 3 months, with domains of home activities, laundry, shopping, and getting places declining the most. Over this time, 18% fell often, and 11% were consistently hospitalized. Between 1 and 3 months follow up, 41% declined in mental component scores, and 50% declined in physical component scores. Low mental and physical component quality of life scores were associated with downstream increased falls and hospitalizations, and decreased quality of life and IADLs. However, change in the four outcome measures was largely independent in factor analysis.

Measuring the four outcome measures over 3 months post-discharge from an ED presentation, showed that changes in one were not generally correlated with changes in another. This result suggests that a wider measurement net could be cast to identify individuals who may not be coping safely or independently in the community after a minor health crisis. Individuals who declined in at least one outcome measure at 1 month, generally continued to decline over the next 2 months, thus suggesting early opportunities to screen and intervene to slow FD.