The assessment of functional status and disability plays an important role in the clinical management of older patients as well as in epidemio¬logic research (see Ch. 17). Chronic and multiple conditions, which are prevalent in those living to late ages, strongly affect level of function¬ing, independence, and need for long-term care.
The ability of a person to perform self-care, known as activities of daily living (ADLs)—such as bathing, dressing, transferring, toileting, and eating—is assessed to determine level of functioning. About 5% to 8% of convmunity-dwelling people > 65 yr old need help in performing one or more ADLs. Further assessment of functioning can be made by measuring the instrumental activities of daily living (lADLs)—such as shopping, preparing food, housekeeping, doing laundry, using trans¬portation, taking medications, handling finances, and using the tele¬phone. The IADLs are necessary for independent living in the commu¬nity. Performance-based measures of functioning entail asking a person to perform a specific task and evaluating it in an objective, standardized manner using predetermined criteria.
Disability can have a major impact on an older person’s ability to live independently. Persons classified in FlG. 105-5 as being dependent in the community live at home but need another person’s help with one or more ADLs or IADLs. With age, the proportion of the population that either resides in a nursing home or lives at home and needs help rises markedly (eg, 46% of men and 62% of women > 85 yr old).
The important chronic diseases associated with disability include those that commonly cause death, such as heart disease, stroke, chronic lung disease, and diabetes, as well as those that are not as likely to cause death but have a great impact on functional status, such as arthritis, osteoporosis, hip fracture, vision and hearing loss, and Alzheimer’s disease. The most common chronic conditions reported by older persons are listed in TABLE 105-4. Of those > 65 yr old, nearly lk report having arthritis, over Vi report having hypertension, and nearly lh report having hearing impairment or heart disease. Some diseases (eg, stroke) are less common but have a profound effect on function.
The prevalence of concurrent multiple chronic diseases (comorbidity) increases with age, and at the oldest ages comorbidity occurs in most people. The prevalence of disability increases stepwise with age and the number of chronic conditions. The burden of morbidity and disability is of great concern to society in planning, financing, and delivering health care and social services to the older population. If current prev¬alence rates of disabling diseases such as arthritis, hip fracture, and Alzheimer’s disease remain unchanged, the numbers of older people