Assessment of Physical Function

 

OBJECTIVE

This nursing care protocol has been designed to help bedside nurses assess and monitor function in older adults, prevent decline, and maintain their function during acute hospitalization.

 

BACKGROUND

A. Functional status of individuals describes the capacity and performance of safe ADL and IADL and is a sensitive indicator of health or illness in older adults. It is, therefore, a critical nursing assessment.

B. Some functional decline may be prevented or ameliorated with prompt and aggressive nursing intervention (e.g., ambulation, toileting schedules, enhanced communication, adaptive equipment, attention to medications and dosages, management of pain).

C. Some functional decline may occur progressively and is not reversible. This decline often accompanies chronic and terminal disease states such as degenerative joint disease, Parkinson disease, dementia, heart failure, and cancer. Interprofessional team care meetings may be helpful in clarifying the trajectory of illness and referring for appropriate follow-up.

D. Functional status is influenced by physiological aging changes, acute and chronic illness, and adaptation to the physical environment. Functional decline is often the initial symptom of acute illness such as infections (e.g., pneumonia, UTI). These declines are usually reversible and require medical evaluation. Functional status is contingent on motivation, cognition, and sensory capacity, including vision and hearing.

E. Risk factors for functional decline include frailty injuries, acute illness, medication side effects, pain, depression, malnutrition, decreased mobility, prolonged bedrest (including the use of physical restraints), prolonged use of Foley catheters, and changes in environment or routines.

F. Additional complications of functional decline include loss of independence, falls, incontinence, malnutrition, decreased socialization, depression, and increased risk for long-term institutionalization and depression.

G. Recovery of function can also be a measure of return to health, such as for individuals recovering from exacerbations of cardiovascular or respiratory diseases and acute infections, from joint replacement surgery, or from new strokes.

H. Functional status evaluation assists patients and their families in planning future care needs post hospitalization, such as short-term skilled care, assisted living, home care, and need for community services or long-term residential care.

I. Physical environments of care with attention to the special needs of older adults serve to maintain and enhance function (e.g., chairs with arms, elevated toilet seat, levers vs. doorknobs, enhanced lighting).

ASSESSMENT PARAMETERS

A. Comprehensive functional assessment of older adults includes independent performance of basic ADL, social activities, or IADL; the assistance needed to accomplish these tasks; and sensory ability, pain level, cognition, and capacity to ambulate.

  1. Basic ADL (bathing, dressing, grooming, eating, continence, transferring)
  2. IADL (meal preparation, shopping, medication administration, housework, transportation, accounting)
  3. Mobility (ambulation, pivoting)

B. Older adults may view their health in terms of how well they can function rather than in terms of disease alone. Strengths should be emphasized, as well as the need for assistance.

C. The clinician should validate, document, and communicate baseline functional status and recent or progressive decline in function.

D. Function should be assessed over time to validate capacity, decline, or progress.

E. Standard instruments selected to assess function should be efficient to administer and easy to interpret. They should provide useful practical information for clinicians and be incorporated into routine history taking, daily assessments, and documentation including electronic medical records.

F. Interprofessional communication regarding functional status, changes, and expected trajectory should be part of all care settings and should include the patient and their family whenever possible.

G. Interprofessional rounds support promotion of function by addressing functional assessment (baseline and current), evaluating potential interventions, and helping develop a plan of care with measurable goals.

H. A patient’s perceptions of function, quality of life, and goals of care should be assessed, documented, and communicated to the care team across all settings.

CARE STRATEGIES

A. Strategies to maximize functional status and to prevent decline while preventing falls

  1. Maintain the individual’s daily routine. Help to maintain physical, cognitive, and social function through physical activity and socialization. Encourage ambulation, encourage the individual to get out of bed for meals, allow flexible visitation, including pets, and encourage reading the newspaper. Encourage adjunctive interventions such as relaxation and music therapy.
  2. Educate older adults, family, and formal caregivers (staff) on the value of independent functioning and the consequences of functional decline; increased risk for complications such as malnutrition, falls, hospital readmissions, and increased likelihood of being discharged to a nursing home setting; increased mortality; and decreased functional recovery, ultimately decreasing quality of life.
    • Physiological and psychological value of independent functioning
    • Reversible functional decline associated with acute illness
    • Strategies to prevent functional decline, including exercise, nutrition, pain management, and socialization
    • Sources of assistance to manage decline
  3. Encourage activity, including routine exercise, range of motion, and ambulation to maintain activity, flexibility, and function.
  4. Minimize bedrest.
  5. Explore alternatives to physical restraint use.
  6. Judiciously use medications, especially psychoactive medications, in geriatric dosages.
  7. Assess and treat for pain. Consider alternative and nonpharmacological interventions.
  8. Design environments with handrails, wide doorways, raised toilet seats, shower seats, enhanced lighting, low beds, and chairs of various types and height, including recliners and rocking chairs.
  9. Help individuals regain baseline function after acute illnesses by using exercise, physical or occupational therapy consultation, nutrition, and coaching.

B. Strategies to help older individuals cope with functional decline

  1. Help older adults and family members determine realistic functional capacity based on health trajectory with interprofessional consultation.
  2. Provide care partner education and support for families of individuals when decline cannot be ameliorated in spite of nursing and rehabilitative efforts. Palliative care consultation may offer the family and team important management strategies, particularly postacute care.
  3. Carefully document all intervention strategies and patient response.
  4. Provide information to care partners on the causes of functional decline related to acute and chronic conditions.
  5. Provide education to address safety care needs for falls, injuries, and common complications. Short-term skilled care for physical therapy may be needed; long-term care settings may be required to ensure safety.
  6. Provide sufficient protein and caloric intake to ensure adequate intake and prevent further decline. Liberalize diet to include personal preferences.
  7. Provide care partner support and community services, such as senior centers, meals on wheels, home care, nursing, and physical and occupational therapy services to manage functional decline.

EXPECTED OUTCOMES

A. Patients can:

  1. Maintain safe level of ADL and ambulation, with less falls
  2. Make necessary adaptations to maintain safety and independence, including assistive devices and environmental adaptations
  3. Strive to attain the highest quality of life despite low functional level
  4. Communicate preferences for care

B. Providers can demonstrate:

  1. Increased assessment, identification, and management of patients susceptible to or experiencing functional decline, and provide routine assessment of functional capacity despite level of care
  2. Ongoing documentation (electronic medical record) and communication of capacity, interventions, goals, and outcomes
  3. Competence in preventive and restorative strategies for function
  4. Competence in identifying risk factors for falls and a plan to address them
  5. Competence in assessing safe environments of care that foster safe independent function

C. Institution will experience:

  1. System-wide incorporation of functional assessment into routine assessments
  2. Reduction in incidence and prevalence of functional decline
  3. Decrease in morbidity and mortality rates associated with functional decline
  4. Reduction in the use of physical restraints, prolonged bedrest, Foley catheters use, and falls
  5. Decreased incidence of delirium
  6. Increase in prevalence of patients who leave the hospital with baseline or improved functional status
  7. Decreased number of falls and fall injuries
  8. Decreased readmission rate
  9. Increased early utilization of nutritional and rehabilitative services (occupational and physical therapy)
  10. Evidence of geriatric-sensitive physical care environments that facilitate safe, independent function, such as low beds and comfortable chairs, and care partner education on safe environmental design and exercise programs
  11. Evidence of continued interprofessional assessments, care planning, and evaluation of care related to function, including posthospital follow-up planning such as leadership support for interdisciplinary communication
  12. Leadership commitment to patient-centered care

RELEVANT PRACTICE GUIDELINES

Several resources are now available to guide adoption of evidence-based nursing interventions to enhance function in older adults.

A. Agency for Healthcare Research and Quality and National Guideline Clearinghouse: www.guideline.gov

B. McGill University Health Centre Research and Clinical Resources for Evidence Based Nursing: https://www.mcgill.ca/nursing/events/links/clinical

C. National Quality Forum: www.qualityforum.org/Home.aspx

D. Registered Nurses’ Association of Ontario. (2005). Clinical practice guidelines. https://rnao.ca/bpg/guidelines

E. Stopping Elderly Accidents, Deaths, and Injuries: https://www.cdc.gov/steadi/index.html

ABBREVIATIONS

ADL          activities of daily living

IADL         instrumental activities of daily living

UTI           urinary tract infection

----

Updated: January 2025

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti, PhD, RN, FAAN, E.A., & Fulmer PhD, RN, FAAN, T. T. (2025). Evidence-Based Geriatric Nursing Protocols for Best Practice (7th ed.). Springer Publishing. Retrieved December 17, 2024, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826152763.html#tableofcontents

Chapter 11, Kresevic, D.M. & Boltz, M. (2025) Assessing Physical Function and Promoting Safe Mobility in the Older Adult

 

REFERENCES

Albasha, N., Ahern, l., O’Mahony, L., McCullagh, R., Cornally, N., McHugh, S., & Timmons, T. (2023). Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: A systematic review, BMC Geriatrics, 23(1), 47. https://doi.org/10.1186/s12877-023-03738-z.Evidence Level I.

Boltz, M., Resnick, B., Chippendale, T., & Galvin, J. (2014). Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults. Journal of the American Geriatrics Society, 62(12), 2398–2407. https://doi.org/10.1111/jgs.13139. Evidence Level III.

Boltz, M., Chippendale, T., Resnick, B., & Galvin, J. (2015). Testing family centered, function-focused care in hospitalized persons with dementia. Neurodegenerative Disease Management, 5(3), 203–215. https://doi.org/10.2217/nmt.15.10. Evidence Level III.

Boltz, M., Mogle, J., Kuzmik, A., BeLue, R., Leslie, D., Galvin, & Resnick, B. (2023). Testing an intervention to improve post-hospital outcomes in persons living with dementia and their family care partners. Innovation in Aging, 7, igad083. https://doi.org/10.1093/geroni/igad083. Evidence Level II

Boltz, M., Monturo, C., Brockway, C., Kuzmik, A., Jones, J. R., & Resnick, B. (2021). Function-focused goal attainment and discharge outcomes in hospitalized persons with dementia. Journal of Gerontological Nursing, 47(9), 13–20. https://doi.org/10.3928/00989134-20210803-01. Evidence Level III.

Boltz, M., Resnick, B., Capezuti, E., Shuluk, J., & Secic, M. (2012). Functional decline in hospitalized older adults: Can nursing make a difference? Geriatric Nursing, 33(4), 272–279. https://doi.org/10.1016/j.gerinurse.2012.01.008. Evidence Level IV.

Boynton, T., Kelly, L., Perez, A., Miller, M., An, Y., & Trudgen, C. (2014). Banner mobility assessment tool for nurses: Instrument validation. American Journal of SPHM,4(3), 86–92. https://www.safety.duke.edu/sites/default/files/BMAT%20for%20Nurses.pdf. Evidence Level IV.

Burns, Z., Khasnabish, S., Hurley, A. C., Lindros, M. E., Carroll, D. L., Kurian, S., Alfieri, L., Ryan, V., Adelman, J., Bogaisky, M., Adkison, L., Ping Yu, S., Scanlan, M., Herlihy, L., Jackson, E., Lipsitz, S. R., Christiansen, T., Bates, D. W., & Dykes, P. C. (2020). Classification of injurious fall severity in hospitalized adults. Journal of Gerontology A Biological Sciences & Medical Science, 75(10), e138-e144. https://doi.org/10.1093/gerona/glaa004.Evidence Level IV.

Chia-Cheng, L., Meardon, S., & O’Brien, K. (2022). The predictive validity and clinical application of Stopping Elderly Accidents, Deaths & Injuries (STEADI) for fall risk screening. Advanced Geriatric Medical Research, 4(3), e220008. https://pubmed.ncbi.nlm.nih.gov/36315107/. Evidence Level IV.

Centers for Disease Control and Prevention. (2023). Older adult fall prevention. https://www.cdc.gov/falls/index.html. Evidence Level IV.

Centers for Medicare & Medicaid Services (2018). State operations manual: Appendix PP—Guidance to surveyors for long term care facilities (Rev. 173). Issued November 22, 2017 from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

CMS.gov. OASIS data sets. https://www.cms.gov/medicare/quality/home-health/oasis-data-sets

Colon-Emeric, C. S., Whitson, H. E., Pavon, J., & Hoenig, H. (2013). Functional decline in older adults. American Family Physician, 88(6), 388–394. https://pubmed.ncbi.nlm.nih.gov/24134046/. Evidence Level V.

Dermody, G., & Kovach, C. R. (2018). Barriers to promoting mobility in hospitalized older adults. Research in Gerontological Nursing, 11(1), 17–27. https://doi.org/10.3928/19404921-20171023-01. Evidence Level III.

de Vries, M., Seppala,L. J., Daams,J. G., van de Glind, E. M. M., Masud, T., van der Velde, N., & EUGMS Task and Finish Group on Fall-Risk-Increasing Drugs. (2018). Fall-risk- increasing drugs: A systematic review and meta-analysis: I. Cardiovascular Drugs. Journal of the American Medical Directors Association, 19(4), 371.e1–371.e9. https://doi.org/10.1016/j.jamda.2017.12.013. Evidence Level I.

Doherty-King, B., & Bowers, B. J. (2013, September). Attributing the responsibility for ambulating patients: A qualitative study. International Journal of Nursing Studies, 50(9), 1240–1246. https://doi.org/10.1016/j.ijnurstu.2013.02.007. Evidence Level IV.

Drolet, A., DeJuilio, P., Harkless, S., Henricks, S., Kamin, E., Leddy, E. A., Lloyd, J. M., Waters, C., & Williams, S. (2013). Move to improve: The feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Physical Therapy, 93(2), 197–207. https://doi.org/10.2522/ptj.20110400. Evidence Level III.

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros, M. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. W. (2020). Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries. JAMA New Open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889. Evidence Level III.

Eekhof, J. A., de Bock, G. H., de Laat, J. A., Dap, R., Schaapveld, K., & Springer, M. P. (1996). The whispered voice: The best test for screening for hearing impairment in general practice? The British Journal of General Practice, 46(409), 473–474. https://pubmed.ncbi.nlm.nih.gov/8949327/. Evidence Level IV.

Emery-Tiburcio, E. E., Mack, L., Zonsius, M. C., Carbonell, E., & Newman, M. (2022). The 4Ms of an Age-Friendly Health System An evidence-based framework to ensure older adults receive the highest quality care. Home Healthcare Now,40(5), 252–257. https://doi.org/10.1097/NHH.0000000000001113.

Feil, M., & Wallace, S. C. (2014). The use of patient sitters to reduce falls: Best practices. PA Patient Safety Advisory, 11, 8–14. https://patientsafety.pa.gov/ADVISORIES/documents/201403_08.pdf. Evidence Level IV.

Fried, L. P., & Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., McBurnie, M. A., & Cardiovascular Health Study Collaborative Research Group. (2001). Frailty in older adults: Evidence for a phenotype. Journal of Gerontology A Biologic Sciences Medical Sciences, 56, M146–M156. https://doi.org/10.1093/gerona/56.3.M146. Evidence Level IV.

Ganz, D. A., Huang, C., Saliba, D., & Shier, V. (2013). Preventing falls in hospitals: A Toolkit for improving quality of care (Prepared by RAND Corporation, Boston University School of Public Health, and ECRI Institute under Contract No. HHSA290201000017I TO #1.). Agency for Healthcare Research and Quality. Evidence Level I.

Glenny, C., Kuspinar, A., & Naglie, G. (2017). A qualitative study of healthcare provider perspective on measuring functional outcomes in geriatric rehabilitation. Clinical Rehabilitation, 32(4), 546–556. https://doi.org/10.1177/0269215517733114. Evidence Level IV.

Growdon, M. E., Shorr, R. I., & Inouye, S. K. (2017). The tension between promoting mobility and preventing falls in the hospital. JAMA Internal Medicine, 177(6), 759–760. https://doi.org/10.1001/jamainternmed.2017.0840. Evidence Level VI.

Gulka, H. J., Patel, V., Arora, T., McArthur, C., & Iaboni, A. (2020). Efficacy and generalizability of falls prevention interventions in nursing homes: A systematic review and meta-analysis. Journal of the American Medical Directors’ Association, 21(8), 10240–10354. https://doi.org/10.1016/j.jamda.2019.11.012. Evidence Level I.

Harris-Kojetin, L., Sengupta, M., Lendon, J. P., Rome, V., Valverde, R., & Caffrey, C. (2019). Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics. Vital Health Statistics, 3(43). https://stacks.cdc.gov/view/cdc/76253. Evidence Level IV.

Hartung, B., & Lalonde, M. (2017). The use of non-slip socks to prevent falls among hospitalized older adults: A literature review. Geriatric Nursing, 38(5), 412–416. https://doi.org/10.1016/j.gerinurse.2017.02.002. Evidence Level V.

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w.Evidence Level I.

Hill, A. M., McPhail, S. M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L., Bulsara, P., & Haines, T. (2015). Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: A pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet385, 2592–2599. https://doi.org/10.1016/S0140-6736(14)61945-0. Evidence Level II.

Hshieh, T. T., Yang, T., Gartaganis, S. L., Yue, J., & Inouye, S. K. (2018). Hospital elder life program: systematic review and meta-analysis of effectiveness. The American Journal of Geriatric Psychiatry, 26(10), 1015–1033. https://doi.org/10.1016/j.jagp.2018.06.007.

Jette, D., Stilphen, M., Ranganathan, V. K., Passek, S. D., Frost, F. S., Jette, A. M. (2014). AM-PAC “6-Clicks” functional assessment scores predict acute hospital discharge destination. Physical Therapy,94, 1252–1261. https://doi.org/10.2522/ptj.20130359. Evidence Level III.

Johnston, Y. A., Bergen, G., Bauer, M., Parker, E. M., Wentworth, L., McFadden, M., Reome, C., & Garnett, M. (2019). Implementation of the stopping elderly accidents, deaths, and injuries initiative in primary care: An outcome evaluation. Gerontologist, 59(6), 1182–1191. https://doi.org/10.1093/geront/gny101. Evidence Level III.

The Joint Commission. (2007). Hospital Accreditation Standards (HAS). JCAHO.

Kannus, P., Sievänen, H., Palvanen, M., Järvinen, T., & Parkkari, J. (2005). Prevention of falls and consequent injuries in elderly people. Lancet, 2005;366(9500), 1885–1893. https://doi.org/10.1016/S0140-6736(05)67604-0. Evidence Level V.

Katz, S. (1983). Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatric Society, 31(12), 721–727. https://doi.org/10.1111/j.1532-5415.1983.tb03391.x. Evidence Level III.

Kirk, A., Behm, K. J., Kimmel, L. A., & Ekegren, C. L. (2021). Levels of physical activity and sedentary behavior during and after hospitalization: A systematic review. Archives of Physical Medicine and Rehabilitation, 102, 1368–1378. https://doi.org/10.1016/j.apmr.2020.11.012. Evidence Level I.

Kresevic, D. M. (2015). The hospitalized elderly. https://www.myamericannurse.com/reducing-functional-decline-hospitalized-older. Evidence Level V.

Kresevic, D. M., & Holder, C. (1998). Interdisciplinary care. Clinics in Geriatric Medicine, 14(4), 787–798. https://doi.org/10.1016/S0749 -0690(18)30091-0. Evidence Level VI.

Kresevic, D. M., & Mezey, M. (1997). Assessment of function: Critically important to acute care of elders. Geriatric Nursing, 186, 216–220. https://doi.org/10.1016/S0197-4572(97)90095-1. Evidence Level V.

Kresevic, D. M., & Pettis, J. L. (2021). Acute Care for Elders (ACE) units-ensuring age-friendly interdisciplinary care of older adults, Geriatric Nursing, 42, 776–779. https://doi.org/10.1016/j.gerinurse.2021.04.006. Evidence Level V.

Kutney-Lee, A., Stimpfel, A. W., Sloane, D. M., Cimiotti, J. P., Quinn, L. W., & Aiken, L. H. (2015). Changes in patient and nurse outcomes associated with Magnet hospital recognition. Medical Care,53(6), 550–557. https://doi.org/10.1097/MLR.0000000000000355.Evidence Level IV.

Kuzmik, A., Resnick, B., Cacchione, P., & Boltz, M. (2021). Physical activity in hospitalized persons with dementia: Feasibility and validity of the MotionWatch 8. Journal of Aging and Physical Activity, 29(5), 852–857. https://doi.org/10.1123/japa.2020-0275. Evidence Level III.

Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179–186. https://doi.org/10.1093/geront/9.3_Part_1.179. Evidence Level IV.

Ley, L., Khaw, D., & Botti, M. (2022). Low dose mobility and functional status outcomes in hospitalized older general medicine patients. Geriatric Nursing, 43, 7–14. https://doi.org/10.1016/j.gerinurse.2021.10.020. Evidence Level III.

Ley, L., Khaw, D., Duke, M., & Botti, M. (2019). The dose of physical activity to minimize functional decline in older general medical patients receiving 24-hr acute care: A systematic scoping review. Journal of Clinical Nursing, 28(1718), 3049–3064. https://doi.org/10.1111/jocn.14872. Evidence Level I.

Lee, S. J., Kim, M. S., Jung, Y. J., & Chang, S. O. (2019). The effectiveness of function focused care interventions in nursing homes: A systematic review. Journal of Nursing Research, 27(1), e9. https://doi.org/10.1097/jnr.0000000000000268. Evidence Level I.

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: State of the science. Clinical Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007. Evidence Level V.

Liu, B., Moore, J. E., Almaawiy, U., Chan, W. H., Khan, S., Ewusie, J., Hamid, J. S., Straus, S. E., & MOVE ON Collaboration. (2018). Outcomes of mobilisation of vulnerable elders in Ontario (MOVE ON): A multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation. Age & Ageing, 47(1), 112–119. https://doi.org/10.1093/ageing/afx128. Evidence Level II.

Mahida, N., & Boswell, T. (2016). Non-slip socks: A potential reservoir for transmitting multidrug-resistant organisms in hospitals? Journal of Hospital Infection, 94, 273–275. https://doi.org/10.1016/j.jhin.2016.06.018. Evidence Level IV.

Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 56–61. https://doi.org/10.1037/t02366-000. Evidence Level III.

Matarese, M., Ivziku, D., Bartolozzi, F., Piredda, M., & De Marinis, M. G. (2015). Systematic review of fall risk screening tools for older patients in acute hospitals. Journal of Advanced Nursing, 71, 1198–1209. https://doi.org/10.1111/jan.12542. Evidence Level I.

Medicare and Medicaid Programs; Hospital conditions of participation: Patients’ rights: Final rule. 42 C.F.R 482. (proposed December 8, 2006). Vol. 712006. 71378–71428. https://www.federalregister.gov/documents/2006/12/08/06-9559/medicare-and-medicaid-programs-hospital-conditions-of-participation-patients-rights

Meneguci, C. A. G., Meneguci, J., Sasaki, J. E., Tribess, S., & Júnior, J. S. V. (2021). Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis. PLoS One, 16(1), e0246275. https://doi.org/10.1371/journal.pone.0246275. Evidence Level IV.

Metzelthin, S. F., Rostgaard, T., Parsons, M., & Burton, E. (2022). Development of an internationally accepted definition of reablement: A Delphi study. Ageing & Society, 42, 703–718. https://doi.org/10.1017/S0144686X20000999. Evidence Level VI.

Morris, P. E., Goad, A., Thompson, C., Taylor, K., Harry B, Passmore, L., Ross, A., Anderson, L., Baker, S., Sanchez, M., Penley, L., Howard, A., Dixon, L., Leach, S., Small, R., Hite, R. D., Haponik, E. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 36(8), 2238–2243. https://doi.org/10.1097/CCM.0b013e318180b90e. Evidence Level III.

Morris, M. E., Webster, K., Jones, C., Hill, A.-M., Haines, T., McPhail, S., Kiegaldie, D., Slade, S., Jazayeri, D., Hneg, H., Shorr, R., Carey, L., Barker, A., & Cameron, I. (2022). Interventions to reduce falls in hospitals: A Systematic review and meta-analysis. Age Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077. Evidence Level I.

National Institute for Health and Care Excellence. (2013). Assessment and prevention of falls in older people. NICE Clinical Guideline 161. https://www.nice.org.uk/guidance/cg161/evidence/full-guideline-pdf-190033741. Evidence Level I.

National Institute for Health and Care Excellence. (2015). Older people: Independence and mental wellbeing. NICE guideline [NG32]. https://www.nice.org.uk/guidance/NG32/chapter/recommendations

Ong, M. F., Soh, K. L., Saimon, R., Wai, M. W., Mortell, M., Soh, K. G. (2021). Fall prevention education to reduce fall risk among community-dwelling older persons: A systematic review. Journal of Nursing Management, 29(8), 2674–2688. https://doi.org/10.1111/jonm.13434. Evidence Level I.

Podsiadlo, D., & Richardson, S. (1991). The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. Journal of American Geriatrics Society, 39(2), 142–148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x. Evidence Level III.

Pountney, D. (2009). Preventing and managing falls in residential care settings. Nursing Residential Care, 11(8), 410–414. https://doi.org/10.12968/nrec.2009.11.8.43320. Evidence Level VI.

Resnick, B. (2012). Changing the philosophy of care—A function-focused care approach. Today’s Geriatric Medicine, 5(2), 34. https://www.todaysgeriatricmedicine.com/archive/031912p34.shtml Evidence Level V.

Resnick, B., Boltz, M., Galik, E., Fix, S., & Zhu, S. (2021a). Testing the implementation of function focused care in assisted living settings. Journal of the American Medical Directors Association, 22(8), 1706-1713.e1. https://doi.org/10.1016/j.jamda.2020.09.026.

Resnick, B., Boltz, M. Galik, E., Fix, S., & Zhu, S. (2021b). Feasibility, reliability, and validity of the MotionWatch 8 to evaluate physical activity among older adults with and without cognitive impairment in assisted living settings. Journal of Aging and Physical Activity, 29(3), 391–399. https://doi.org/10.1123/japa.2020-0198. Evidence Level III.

Resnick, B., Galik, E., & Boltz, M. (2013). Function focused care approaches to care for older adults: Literature review of progress and future possibilities. Journal of the American Medical Directors Association,14(5), 313–318. https://doi.org/10.1016/j.jamda.2012.10.019. Evidence Level V.

Reynolds, C. D., Brazier, K. V., Burgess, E. A. A., Golla, J. A., Le, J., Parks, B. A., O’Hoski, S., & Beauchamp, M. K. (2021). Effects of unstructured mobility programs in older hospitalized general medicine patients: A systematic review and meta-analysis, Journal of the American Medical Directors Association, 22(10), 2063–2073.e6. https://doi.org/10.1016/j.jamda.2020.12.008. Evidence Level I.

Rubenstein, L. Z. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing,  35(Suppl 2), ii37–ii41. https://doi.org/10.1093/ageing/afl084. Evidence Level V.

Saliba, D., & Buchanan, J. (2009). Development and validation of a revised nursing home assessment tool: MDS 3.0. Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/downloads/MDS30FinalReport.pdf. Evidence Level III.

Sallis, J., Bull, F., Guthold, R., Heath, G. W., Inoue, S., Kelly, P., Oyeyemi, A. L., Perez, L. G., Richards, J., Hallal, P. C., & Lancet Physical Activity Series 2 Executive Committee. (2016). Progress in physical activity over the Olympic quadrennium. The Lancet, 388(10051), 1325–1336. https://doi.org/10.1016/S0140-6736(16)30581-5. Evidence Level V.

Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J., Kessler, L. A., & Miller, S. T. (2012). Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: A cluster randomized trial. Annals of Internal Medicine, 157, 692–699. https://doi.org/10.7326/0003-4819-157-10-201211200-00005. Evidence Level II.

Shorr, R. I., Guillen, M. K., Rosenblatt, L. C., Walker, K., Caudle, C. E., & Kritchevsky, S. B. (2002). Restraint use, restraint orders, and the risk of falls in hospitalized patients. Journal of the American Geriatric Society, 50, 526–529. https://doi.org/10.1046/j.1532-5415.2002.50121.x. Evidence Level IV.

Spetz, J., Brown, D. S., & Aydin, C. (2015). The economics of preventing hospital falls: Demonstrating ROI through a simple model. Journal of Nursing Administration, 45(1), 50–57. https://doi.org/10.1097/NNA.0000000000000154. Evidence Level III.

Sternberg, S. A., Rochon, P. A., & Gurwitz, J. H. (2021). Focusing on medications that increase the risk of falls in older adults. European Geriatric Medicine, 12, 671–672. https://doi.org/10.1007/s41999-021-00448-w.

Tinetti, M. E., & Ginter, S. F. (1998). Identifying mobility dysfunctions in elderly patients. Standard neuromuscular examination or direct assessment? Journal of the American Medical Association, 259(8), 1190–1193. https://doi.org/10.1001/jama.1988.03720080024022.Evidence Level III.

Trotta, R. L., & Kornet, T. (2016). Informational technology: Embedding geriatric clinical practice guidelines. In M. Boltz, E. Capezuti, D. Zwicker, & T. Fulmer (Eds.), Evidence-based geriatric nursing protocols for best practice (6th ed. pp. 21–26). Springer. Evidence Level V.

U.S. Department of Health and Human Services. (2018). Physical activity guidelines for Americans (2nd ed.). U.S. Department of Health and Human Services; 2018.

Wells, C., Pittas, J., Roman, C., Lighty, K., & Resnick, B. (2021). Reliability and validity of the UMove mobility screen. Journal of Nursing Measurement, 30(3), 1–10. https://doi.org/10.1891/JNM-D-21-00001. Evidence Level III.

Zisberg, A., Agmon,M., Gur-Yaish, N., Rand, D., Hayat, Y., & Gil, E., & WALK-FOR team. (2018). No one size fits all-the development of a theory-driven intervention to increase in-hospital mobility: The “WALK-FOR” study. BMC Geriatrics, 18(1), 91. https://doi.org/10.1186/s12877-018-0778-3. Evidence Level III.

Protocols

Symptoms

More Information