Assessment of Physical Function
Protocol 6.1: Assessment of Physical Function (cont.)
VII. RELEVENT PRACTICE GUIDELINES
Several resources are now available to guide adoption of evidenced based nursing interventions to enhance function in older adults.
A. Agency for Healthcare Research and Quality & National Guideline Clearing- house; http://www.guideline.gov/
B. McGill University Health Centre Research & Clinical Resources for Evidence Based Nursing; http://www.muhc-ebn.mcgill.ca/
C. National Quality Forum; http://www.qualityforum.org/Home.aspx
D. Registered Nurses Association of Ontario. (2005). Clinical practice guidelines.
Retrieved from http://www.rnao.org/Page.asp?PageID=861&SiteNodeID=27 0&BL_ExpandID
E. University of Iowa Hartford Center of Geriatric Nursing Excellence. Evidence- based practice guidelines. Retrieved from http://www.nursing.uiowa.edu/hartford/
nurse/ebp.htm
Protocol 6.1: Assessment of Physical Function (cont.)
ResOURces
Agency for Healthcare Research and Quality & National Guideline Clearinghouse http://www.guideline.gov/
McGill University Health Centre Research & Research and Clinical Resources for Evidence Based Nursing http://www.muhc-ebn.mcgill.ca/
National Quality Forum
http://www.qualityforum.org/Home.aspx
Registered Nurses Association of Ontario. Clinical practice guidelines.
http://www.rnao.org/Page.asp?PageID=861&SiteNodeID=270&BL_ExpandID
University of Iowa Hartford Center of Geriatric Nursing Excellence. Evidence-based practice guidelines.
http://www.nursing.uiowa.edu/hartford/nurse/ebp.htm
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104
eDUcATIOnAL OBjecTIVes
On completion of this chapter, the reader should be able to:
1. discuss the functional trajectory of the hospitalized older adult 2. identify risk factors for functional decline
3. describe the influence of the care environment upon physical function
4. discuss interventions to optimize physical function of hospitalized older adults OVeRVIeW
As described in Chapter 6, Assessment of Function, functional decline is a common complication in hospitalized older adults, even in those with good baseline function (Gill, Allore, Gahbauer, & Murphy, 2010). Loss of physical function is associated with poor long-term outcomes, including increased likelihood of being discharged to a nursing home setting (Fortinsky, Covinsky, Palmer, & Landefeld, 1999), increased morbidity and mortality (Boyd, Xue, Guralnik, & Fried, 2005; Rozzini et al., 2005), increased rehabilitation costs, and decreased functional recovery (Boyd et al., 2008;
Boyd et al., 2005; Gill, Allore, Holford, & Guo, 2004; Volpato et al., 2007). The immobility associated with functional decline results in infections, pressure ulcers, falls, a persistent decline in function and physical activity and nonelective rehospital- izations (Gill et al., 2004).
The promotion of function is a basic gerontological tenet, and functional status is a key determinant of quality of life for older adults (Boltz, Capezuti, Shabbat, & Hall, 2010). Although the acute care setting, with its focus on correcting the admitting medical problem, typically prioritizes nursing tasks such as medication administration, coordina- tion of care, and documentation over the promotion of function as a clinical outcome, there is growing awareness of the need to attend to the functional status of the hospitalized older adult (Nolan & Thomas, 2008). Older adults themselves expect that an acute care