Identifying indicators of early functional decline in community-dwelling older people: a review

Functional decline is an insidious-onset manifestation of aging, which can be overlooked in its early stages. Current screening measures for incipient functional decline are generally applied at one point-in-time, in hospital wards or emergency departments when older people are in health crisis. This potentially provides an imprecise estimate of the situation. In line with internationally recognized challenges of dealing with the needs of aging populations, it is essential that sensitive screening for incipient functional decline occurs much earlier, in familiar community settings. The present review presents an evidence-based synthesis of features, measures and/or manifestations of early functional decline in community-dwelling older individuals. A systematic search was carried out to collate indicators of early functional decline. These were then organized into constructs, which reflected the principal measurement intent as identified by the author of each article. A total of 146 articles (reporting 195 psychometrically sound measurement tools, representing 107 constructs) were included in the review. The constructs were then clustered into six broad health domains: medical status, performance capacity, participation, demographics, anthropometry and relationships with health providers. These domains were developed after consultation with a range of allied health professionals and a consumer representative. The present review provides the first known evidence-based synthesis of indicators of early functional decline in older community-dwelling people, and shows the range of constructs that need to be considered in assessment for early functional decline.