Table 1.
Diagnostic Tools and Maneuvers to Identify Specific Impairments and Contextual Factors Contributing to Disability in Older Adults
| Screening tool or maneuver17 | Function or impairment assessed |
Associated functional limitations |
Potential interventions |
|---|---|---|---|
| Neuromusculoskeletal tests17,18 | |||
| Clasp hands behind head and behind back19 | Internal and external rotation and abduction of the shoulder, elbow flexion | Dressing (especially upper body), grooming, bathing, housework | Treat musculoskeletal conditions and associated pain; flexibility exercises; occupational therapy |
| Place ankle on opposite knee19 | External rotation of the hip, hip and knee flexion | Dressing lower body, bathing, toileting | |
| Chair stand test18,20 (stand from a chair without using arms; assess qualitatively or time five consecutive attempts) | Lower extremity strength (especially hip and knee) | Bathing, toileting, falls | Treat reversible neuromuscular and musculoskeletal conditions and associated pain; balance and strength exercises; rolling walker; raised toilet seat; bath chair; physical therapy |
| Rise on toes21 (test single heel rise in healthy adults, bilateral heel rise in frail adults) | Lower extremity strength (especially ankle), balance | Stair climbing, housework, bathing, falls | |
| Gentle nudge to the sternum22 | Ankle, hip, and trunk strength; balance | Housework, bathing, falls | |
| Timed Up and Go test23 (stand from a chair without using arms, walk 10 ft, return, sit down; see http://www.youtube.com/watch?v=s0nqzvt9JSs) | Lower extremity strength (especially hip and knee), balance, gross motor coordination | Mobility, bathing, toileting, housework | |
| Pick up a penny from the floor22 (to isolate hand function from sitting balance and vision, place penny on table or opposite hand) | Pinch strength, sensation, fine motor coordination, sitting balance, vision | Cooking, feeding, grooming, dressing, housework | Vision assessment and treatment; easy-to-manage clothing; occupational therapy |
| Two-minute walk test24 (walk at usual pace for two minutes; measure distance) | Endurance | Community mobility, shopping | Treat reversible cardiovascular, pulmonary, and musculoskeletal conditions; aerobic exercise; scooter or wheelchair |
| Sensory and cognitive tests | |||
| Whisper test25 | High-frequency hearing | Social function, telephone use; patient may mistake hearing problems with memory loss | Amplification devices |
| Read a line of 11- to 12-point type26 | Near vision | Medication management, reading | Treat reversible ophthalmologic conditions; magnification devices; referral to low-vision rehabilitation; pill box |
| Snellen chart testing26 | Distance vision | Driving | |
| Geriatric Depression Scale27 (score of 5 or higher suggests depression) | Mood | Short-term memory, social function | Antidepressants, cognitive behavior therapy |
| Time and Change Test28 (tell the time from a clock face set at 11:10, then make $1 in change from three quarters, seven dimes, and seven nickels; incorrect response on either task suggests possible dementia) | Cognition | Instrumental activities of daily living | Consider cholinesterase inhibitor; driving and home safety evaluation; family education and support |
| Clock Drawing Test29 (draw a clock face with hands at 11:10; errors in number or hand placement suggest need for further evaluation) | Executive function | Medication management, financial management, social function | Consider referral for neuropsychological testing |
| STOPP (screening tool of older persons’ potentially inappropriate prescriptions) criteria30 | Medication use | Short-term memory, balance, falls | Taper and stop medication when possible |
| Contextual factors | |||
| Ask “Do you have trouble with stairs inside or outside of your home?”31 | Physical environment and home safety | Falls, social function | Home safety evaluation; physical or occupational therapy; assistive devices; bathroom equipment |
| Ask “How confident are you that you can take a bath or shower, or get on and off the toilet without falling?”32 | Physical environment and home safety | Falls, hygiene | |
| Ask “Who would be able to help you in case of illness or emergency?”31 | Social support | Weight loss, medication management, financial management, social function | Social worker evaluation, community services or home health agency referral |
| Caregiver Burden Scale33 (scores higher than 40 indicate moderate to severe burden) | Caregiver stress | Decreased social function resulting from decreased caregiver support of community roles | |
| Mini Nutritional Assessment short form34 (score of 8 or less indicates risk of malnutrition) | Nutrition | Weight loss, physical performance | Nutritional supplements, nutrition evaluation |