July 2015
Swank Health: Your monthly news from Swank HealthCare


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Did You Know?

Preventing Functional Decline in Elderly Patients

Top List
What's Going On?

Top Challenges Faced by Nursing Executives
Swank HealthCare Hosts Webinar with Rebecca Smallwood

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Take this quick quiz to test your knowledge on functional decline, delirium and medication use in elderly patients.

Recommended Readings

Recommended Courses*
  • 313411 Cognitive Screening of the Elderly in Primary Care
  • 63215 Geriatric Medication Management
  • 36115 Protecting the Elderly and Advocating for Social Change: Part 1
  • 36215 Protecting the Elderly and Advocating for Social Change: Part 2

* course numbers may vary by facility


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Did You Know?

Preventing Functional Decline in Elderly Patients

Did you know that up to 50% of elderly patients experience functional decline during hospitalization that is independent of their presenting medical illness? Functional decline is a loss in the ability to perform activities of daily living (ADLs) such as: bathing, dressing, eating, transferring from bed to chair and toileting. It can lead to prolonged hospital stays, poor satisfaction of care, higher readmission rates and for about 23% of elderly patients, the inability to live independently following hospitalization.

As people age, they become more frail and suffer multiple conditions like, arthritis, cognitive impairment, joint disease and heart and respiratory failure. These aspects reduce the ability to rebound from acute illnesses, physical impairments, abnormal routines and adverse events. Hospital-acquired conditions, such as catheter-associated urinary tract infections, pressure ulcers and falls are among factors that place elderly patients at increased risk for functional decline. Other common factors are immobility, altered sleep-wake cycles, disorienting effects of medications and the environment and altered nutritional status.

Predictors of functional decline include:

  • Advanced age
    • Age 70-74: 23% experience a loss of ADL function
    • Age 75-79: 28%
    • Age 80-84: 38%
    • Age 85-90: 50%
    • 90+: 63%
  • Cognitive impairment
  • Lower baseline functional status
  • Pre-admission disability in mobility (use of a cane or walker)
  • Delirium
  • Depression
  • Length of Hospital Stay

Strategies to optimize the elderly patient’s functional outcomes during hospitalization should begin with a brief, structured assessment to establish a baseline, along with measures to prevent decline, which should be implemented immediately upon admission. The geriatric functional assessment should include:

  • Basic ADLs and Independence of Activities of Daily Living (IADLs), which include the ability to take medications independently, handle finances and household tasks, drive or use public transportation and use a telephone
  • Mobility through self-reports or observation of gait, transfer from chair to standing and walking
  • Cognitive function to assess for signs of dementia and delirium
  • Depressive symptoms
  • Nutritional status, especially protein-energy malnutrition which is suspected when there is a history of weight loss, muscle atrophy, low levels of serum proteins or anemia and low serum cholesterol.

The following tips are useful when communicating with and assessing elderly patients to maximize a meaningful exchange.

  • Don’t sit in front of a window or other light source
  • Face the patient, sitting at eye level, allowing the patient to see your lips
  • Don’t multi-task or appear to be rushed
  • Encourage the patient to wear glasses or hearing devices if needed
  • Use a well-lighted room
  • Eliminate as much extraneous noise as possible
  • Speak slowly and use common, “living-room language,” avoiding the use of medical terminology
  • When needed show or draw pictures to enhance understanding
  • Use teach-back or show-me to confirm understanding
  • Allow plenty of time for the patient to ask and answer questions
  • Use open-ended interviewing
  • Always be respectful, caring and compassionate

What's Going On?

Top Challenges Faced by Nursing Executives:

Swank HealthCare recently took a poll, asking nurse executives what challenges they face in their daily work routine.

More Information »

Swank HealthCare Hosts Webinar with Rebecca Smallwood

On April 30, Rebecca Smallwood conducted a webinar on the Road to Patient Safety. In this she described strategies, progress and the challenges along with ways to improve the patient’s safety and healthcare quality...

More Information »


Recommended Readings


Top List

Prevention is vitally important in improving the outcomes of elderly patients with acute illness or surgical needs. Here are the top 10 strategies for maximizing functional status and preventing decline.

  1. To the greatest extent possible, maintain the patient’s normal, daily routine. Assist with room lighting to match time of day and maintain a quiet environment, especially during evening and night hours to encourage regular sleep. Encourage patients to perform regular ADLs as independently as possible with close monitoring and assistance when needed.
  2. Engage older adults, family members and caregivers about the importance of maintaining functional status and teach strategies to prevent decline, including: physical activity, nutrition, pain management, fall prevention and socialization.
  3. Encourage frequent ambulation and range of motion exercises to maintain flexibility and function. Assess and treat pain that may reduce physical activity.
  4. Encourage the use of assistive devices, such as: hearing aids, glasses and walkers.
  5. Routinely screen for delirium and changes in cognitive function.
  6. Implement established protocols to prevent hospital-acquired conditions and other adverse events, such as catheter-associated urinary tract infections, pressure ulcers and falls.
  7. Obtain the best possible medication history. Reconcile, review and optimize medications.
  8. When possible, avoid drugs known to induce confusion and delirium, such as:
    • Antihistamines (diphenhydramine, hydroxyzine)
    • Narcotic analgesics (meperidine, propoxyphene)
    • Benzodiazepines (Diazepam, Chlordiazepoxide)
    • Tricyclic Antidepressants (Amitriptyline, Imipramine, Doxepin)
    • Histamine -2 Receptor Antagonists: (Famotidine)
  9. Seek alternatives to physical restraints and other devices such as IV poles and urinary catheters that limit physical activity.
  10. Closely monitor and correct fluid and electrolyte imbalances – serum sodium, potassium, glucose; dehydration and fluid overload.

Now Trending

Take this quick quiz to test your knowledge on functional decline, delirium and medication use in elderly patients.

Bedrest and immobility result in a decline in strength by about ____ per day.

A. 1-2%
B. 2-5%
C. 5-8%
D. 8-10%

What percentage of elderly patients develop new episodes of delirium while in an acute care environment?

A. 5-10%
B. 10-20%
C. 20-30%
D. 30-50%

What percentage of elderly patients report taking 5 or more medications daily?

A. 10%
B. 25%
C. 50%
D. 70%


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Answer: : B. 2-5%

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D. 30-50%

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C. 50%

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