Daniel Liebzeit1, Barbara King, Lisa Bratzke, Marie Boltz. 1. Daniel Liebzeit, RN-BSN, is a nurse by background and PhD candidate at the University of Wisconsin-Madison School of Nursing with research focusing on advancing knowledge of functional status in older adults and improving outcomes during the transition from hospital to home. Barbara King, PhD, RN, is a geriatric nurse practitioner and Assistant Professor in the University of Wisconsin-Madison School of Nursing. She is dedicated to creating sustainable and scalable practice change to promote patient safety for hospitalized older adults. Lisa Bratzke, PhD, RN, is an adult nurse practitioner and Assistant Professor in the University of Wisconsin-Madison School of Nursing. Her research interests include examining the effects of accelerated cognitive decline on functional status and self-management, two important factors related to an older adult's ability to live independently. Marie Boltz, PhD, RN, is a geriatric nurse practitioner and Associate Professor in the Pennsylvania State University College of Nursing. Her research includes examination of complex aging-related care issues and interventions to promote functional health and cognition in older adults.
Abstract
PURPOSE/ OBJECTIVES: The purpose of this article is to highlight how scientists have assessed all components of functional status in older adults transitioning from hospital to home to date, discuss ways of improving assessment of functional status, and discuss implications for case management research and practice. PRIMARY PRACTICE SETTING(S): This article focuses on case management of older adults transitioning from hospital to home. FINDINGS/ CONCLUSIONS: There any many ways to assess functional status, including basic activities of daily living (BADL), instrumental activities of daily living (IADL), and other nonphysical domains of function such as leisure, social, and productive activities. However, assessment of function in older adults transitioning from hospital to home is primarily limited to BADL. Nonphysical domains of functional status have been linked to important outcomes in community-dwelling older adults and could give clinicians and researchers a better understanding of how older adults are functioning, as well as allow for earlier recognition of those who are beginning to experience functional decline. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: In case management, it is important to ask older adults about goals regarding their functional status and how they think about their functioning in the hospital and at home. Early identification of older adults' functional goals while in the hospital is the first step toward regaining their ideal or premorbid function after discharge to home. To best determine baseline functional status, we may need to consider assessments that can measure multiple domains of functioning in older adults, such as the Sickness Impact Profile. Gaining a more comprehensive understanding and assessment of functional status for hospitalized older adults would help inform discharge destinations and improve transitions in care.
PURPOSE/ OBJECTIVES: The purpose of this article is to highlight how scientists have assessed all components of functional status in older adults transitioning from hospital to home to date, discuss ways of improving assessment of functional status, and discuss implications for case management research and practice. PRIMARY PRACTICE SETTING(S): This article focuses on case management of older adults transitioning from hospital to home. FINDINGS/ CONCLUSIONS: There any many ways to assess functional status, including basic activities of daily living (BADL), instrumental activities of daily living (IADL), and other nonphysical domains of function such as leisure, social, and productive activities. However, assessment of function in older adults transitioning from hospital to home is primarily limited to BADL. Nonphysical domains of functional status have been linked to important outcomes in community-dwelling older adults and could give clinicians and researchers a better understanding of how older adults are functioning, as well as allow for earlier recognition of those who are beginning to experience functional decline. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: In case management, it is important to ask older adults about goals regarding their functional status and how they think about their functioning in the hospital and at home. Early identification of older adults' functional goals while in the hospital is the first step toward regaining their ideal or premorbid function after discharge to home. To best determine baseline functional status, we may need to consider assessments that can measure multiple domains of functioning in older adults, such as the Sickness Impact Profile. Gaining a more comprehensive understanding and assessment of functional status for hospitalized older adults would help inform discharge destinations and improve transitions in care.
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