Assessment of Function
(A tool for effective caregiving)
Negotiating the uncertain and perhaps uncharted waters of the care-giving experience can be overwhelming for anyone. Driven by the desire to do what is “best” for your loved one, you may find yourself in the uncomfortable position of not really knowing what actually is best for your elderly or ill relative or friend.
Getting an assessment of your loved one’s daily functioning can provide you and your family with a starting point from which to approach your care-giving tasks – to help you maximize the quality of life of the individual in need of your care.
Practical information about your relative’s abilities and limitations can give you a greater understanding of the impact of the illness, disability or aging on your loved one. This can help you be better prepared to deal with the day-to-day challenges you can expect to face and may help you avert crisis situations.
What is an assessment of function?
An assessment of function (or functional assessment) involves a practical investigation into an individual’s ability to perform activities of daily living – tasks that are usual for them. It provides practical suggestions on how to use techniques or resources to help your situation and help prevent misunderstanding, frustration and caregiver burnout.
Daily functioning refers to the tasks or activities we all complete in a day as part of our usual roles and responsibilities. For instance, personal care activities can include bathing, grooming, going to the toilet, getting dressed and preparing meals. Occupational or productive activities are any activities related to working, maintaining our home (cleaning, laundry, shopping, managing finances, etc.) or participating in community or volunteer tasks. Leisure activities are those we do for pleasure or interest (hobbies, recreation, etc.).
Illness, disability and aging can all have an impact on an individual’s ability to participate in the daily tasks they are used to doing as part of their routine. For example, arthritis may limit a person’s ability to do the cooking, due to pain, stiffness and decreased joint movement. Decreased vision or hearing in an elderly person may make engaging in social activities extremely frustrating and unrewarding, often leading to social isolation.
An assessment can take place in a person’s own home or in a clinic setting. Techniques used may include an interview, observing behaviour, pen and paper activities, physical assessment of arm/leg strength and joint movement, and actually doing activities (e.g. kitchen activities) while being supervised. An assessment will last a minimum of two hours to a few sessions over several days, depending on the type and detail required.
Who conducts the assessment?
Many health care professionals are qualified to perform functional assessments. However, each professional approaches this task from a particular point of view depending on their training and scope of practice. The specific needs or problems experienced by your loved one will lead you to choose to have an assessment of a specific area of function (e.g. physiotherapy) or an assessment of overall function in daily activity (e.g. occupational therapy).
What can I expect to learn about my loved one through an assessment?
An assessment provides you with a comprehensive perspective about your relative’s strengths and limitations regarding specific areas of function. When I conduct an occupational therapy assessment, I gather information about the following areas:
- identified by family
- displayed by client
- life roles
- medical history
- past medical conditions
Current daily routines, abilities and difficulties:
- household cleaning
- meal preparation
- pet care
Assistive devices used and environmental adaptations
- cognition (memory, insight, judgment, problem solving)
- psychological (mood, emotions)
- sensory (hearing, vision)
- physical skills (strength, movement, mobility)
The information is summarized in a written report. It lists strengths and limitations that directly affect daily behavior and ability, and provides specific recommendations to help your loved one in an effective way. Included in the report are relevant resources and community information.
How can I use the information to be a more effective caregiver?
Let’s look at an example of a person with dementia. An assessment may identify that the person has perceptual problems that result in difficulties with correct interpretation of what he sees in his environment. In addition, he may have communication problems that appear as limited ability to verbally state his needs. As a result, you may be embarrassed and upset to find that your loved one urinates in the round, white garbage can in the hallway. His disorders of perception, cognition and communication result in a misinterpretation of a low, round, white object as a toilet. As well, simply seeing this “toilet” stimulates his need to urinate.
An assessment of cognitive, perceptual and communication skills will explain such behaviour. You may receive recommendations to remove the garbage can to a less obvious location and escort your relative to the toilet every two to three hours to compensate for his inability to appropriately state his needs. The assessment will offer you practical guidance that can help you maintain your loved one’s dignity and well-being.
This written report will be useful not only to you as a caregiver, but will be appreciated by other care professionals involved in your loved one’s care. Working together as a team, professionals, family and the person being cared for can help do what is “best.”
From your own observations as a caregiver you will likely have a tremendous amount of information about the impact of illness or disability on your loved one. A thorough functional assessment will assist you and your loved one to travel through the caregiving relationship with strength, support and dignity.
Professionals Who Do Functional Assessments
||Use activities as the basis of understanding functioning and behaviour. They look at all areas of function – physical, cognitive (mental), psychological, social and communication – and try to view the person as a whole. They also look at the environment as adaptations may be required to maximize ability.
||Also addresses’ whole person functioning but tend to have specific expertise in areas such as medication management, skin care, emotional support, basic medical status, specific disease management and education.
||Are skilled in performing detailed psychological tests and evaluations of memory, attention, concentration and personality. By gaining a concentrated perspective on objective tests, psychologists can often offer detailed information about mental and emotional functioning.
||Are also concerned with overall functioning and offer specific expertise in assessment of physical and mobility skills.
||Offer specialized understanding of relationship functioning, particularly within families and couples.
Article By: Aruna L.Mitra, B.Sc., OT
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