Are the ADL (Activities Daily Living) in the geriatric reports based on the real examinations of patients during their living activities or, some times, are only based on the description reported by others?
The best way to evaluated is asking to the caregiver/family member. because most of the times we remove the bias of cognitive impairment and anosognosia.
or ask the patient about, make sure you use the right instrument!
remember the gender differences!
hope it helps you.
Thanks Elkin for your answer.
But in the case of geriatric evaluation for medico - legal purposes (for instance, medical examination for civil invalidity), is it suitable the information received only by family members or caregivers?
Thanks Jordi.
In Italy, in my medico legal activity for the National Social Security Institute, I have noticed that sometimes in geriatric reports describing patients suffering of major cognitive decay (MMSE
Thank you Jordi. Your long-winded answer is detailed and explaines the discrepancies beetween cognitive impairments and non autonomy in DL. Thanks.
Dear collegue,
I understand your doubts very well. In my medical practice like geriatrician I have often evalueted patients for medico-legal purposes. Sometimes caregivers try to take worse patient's disability. In Italy observation of the geriatric patients in their real life is impossible. Thus assessment of patient's frailty under a pathological pount of view, tests for evaluation of depression (like a short geriatric depression scale) and for functional limitations (like tinetti scale) can give more informations to clinician in spite of ADL and IADL scales only. I think that a multidimensional evaluation, togheter with the personal experience of the clinician,are the better instruments to achieve a realistic measure of the patient's disability.
Best regards
The evaluation should be a mix of methods. The patient should be assessed taking into consideration, the medical condition, medication, mental health, degree of frailty, reports from appropriate practitioners, relatives' view point. The experience and the amount of contact that practitioners have with the patient are also important. Observations need to be ongoing, not a one off/
Dear college: I have taken part in the National Project named "Comprehensive assessment in China". We used various scales on Functional assessment. During clinical practice, the functional performance of different patients, based on independence or dependence, Therefore, in the final comprehensive assessment, we determine the final score due to different combination of individual-based scales. As ADL or IADL, we have assessed 9900 population-based individuals, with an extreme 14+-1 high average score. Due to this results, we concluded that ADL is better used to get an initial impression (screening) in dependence, instead of accurate assessment clinically. Considering the high heterogeneity in the aging population, we suppose that ADL itself can not provide high specificity*sensitivity on clinical integrative Aging assessment. Indeed, the largest advantage of ADL is the stable scoring system with limitation intra- and intro- observers bias. The confused discrepancy in clinical application has been due to the high heterogeneity in the elderly. In our clinical project, aiding by advanced statistical modeling,we have established a comprehensive tool including six dimensions (multi-morbidity, multi-symptoms,function, cognition, psychology,and socioecomonic status) . And I am engaged myself on compose a review named " Miscellanea of instruments on comprehensive ageing assessment". I will share it after it has been published and I wish it will help you to disentangle the present dilemma. Thank you.
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