Change in functional disability of geriatric patients in a family medicine program: implications for patient care

Multi-dimensional functional impairments of a sample of 130 new patients, aged 60 years and older, at a family medicine center were previously described. Of these, 48 persons representing the combinations of impairment originally present were selected by means of modified random sampling for follow-up 13 to 27 months later (m = 20 months). Patients were assessed both at the time of the initial visit and on follow-up with the Older Americans Resources Services (OARS) Multi-dimensional Functional Assessment Questionnaire, an instrument permitting assessment of functional status in five areas of personal functioning: social, economic, mental health, physical health, and the ability to perform activities of daily living (ADL). Fourteen of the 130 initial subjects died during the follow-up interval. Impairments in mental health, physical health, and ADL were associated with increased risk of mortality; but impairments in social and economic functioning did not increase risk. For the survivors there was decline in economic and mental functioning and little, if any, change in social resources or the ability to perform activities of daily living. However, there was notable improvement in their physical functioning.