The time “up and go” test correlates with balance, gait speed, and functional capacity. The patient is asked to rise from an armchair, walk 3 m, turn, return to the chair, and sit. For screening, the authors suggest 10 seconds as the cutoff for patients to be described as “freely mobile,” which appears to predict the patient’s ability to go outside safely. Moore and Siuused 15 second for the screening cutoff.
Lachs and colleagues preferred an untimed approach, simply observing the patients and assessing the ability to complete the task many emergency physicians routinely perform untimed up and go” test observing the patient rise from the stretcher, walk, turn, and then return to the stretcher with or without assistance. Qualitative assessment such as this may behelpful as part of functional screening in the ED. When impairments are found, more formal testing and appropriate disposition planning are required.
Lachs and colleagues developed to brief functional assessment for use in ambulatory settings. They recommend testing vision with a Jaeger card; hearing using the whisper test ; proximal and distal arm mobility, leg strengthand mobility with an untimed ‘’ up and go’’ test; urinary continence via question; nutrition by weight and height; mental status by three-items recall; depression by question; home environment by questions; and social support by asking, “Who would be able to help ypu in case of illness or emergency?” ADLs and IADLs were assessed by asking about four items: ability to get up of bed, dress, preparemeals, and shop by onself.
Functional decline in old age
Functional Decline Is A Common Condition, occurring each year in nearly 12% of Canadians 75 years of age and older. The model of functional health proposed by the World Health Organization (WHO) represents a useful theoretical framework and is the basis for the SMAF (Système de mesure de l’autonomie fonctionelle or Functional AutonomyMeasurement System), an instrument that measures functional autonomy. The functional decline syndrome, in which functional autonomy is diminished or lost, may present as an acute condition, i.e., a medical emergency for which the patient must be admitted to a geriatric assessment unit. The subacute form is a more insidious condition in which the patient requires comprehensive assessment and arehabilitation program. A preventive approach based on screening of those at risk and early intervention should prevent or delay the appearance of functional decline or diminish its consequences. Effective strategies for the prevention of or rehabilitation from functional decline will help reduce the incidence of disabilities and the period of dependence near the end of life. These strategies areabsolute prerequisites for controlling sociohealth expenses and, most importantly, for allowing people to live independently in old age.
The demographic importance of the elderly population is gradually increasing in Quebec and all of Canada. In 1978 those over 65 years of age represented only 8.2% of the Quebec population, but by 1990 this group had increased to 11% of the population and by the year2020 it will exceed 18%. In the space of 40 years, Canada will have left the ranks of the countries with young populations to join those with old populations. Furthermore, there is also a marked aging within the elderly group itself: the 80-plus age group will increase from its current proportion of 18% of those over 65 to reach 21.5% by the beginning of the 21st century.
One of the reasons forthis aging of the population is the decrease in the birth rate. However, another reason is the increase in life expectancy at birth, which is currently 80.8 years for women and 73.7 years for men. Of those who are now 65 years old, women can expect to live 20.1 more years on average and men 15.5 more years. However, a substantial portion of that period (6.9 years for women and 4.0 years for...