Information 1-3

  • Monitoring functional capacity and safety as people age, allows for early intervention to ensure a continued safe healthy quality of life

Health check recommendations

  • All adults > 50 years of age annually

1. Procedure

  • Ask the questions and explore as per Table 1.
  • Identify any risks of harm due to deteriorating capacity or risky episodes. Be mindful of those at risk of Domestic and family violence
  • Provide brief intervention and resources as required
  • Determine if the person requires a referral and place onto a follow-up and recall register

Table 1. Functional capacity and safety questions

Questions

Explore

Is the person able to care for themselves?

  • Which activities of daily living are difficult and why?

Has the person had any falls in the last 3 months?

  • What were they doing at the time?
  • How did it happen?
  • Were they hospitalised? Have they recovered fully?

Can the person manage their own medicines?

  • Are they taking medicines correctly?
  • Do they know what the medicines are for?
  • Are there any side effects?
  • Are there too many prescriptions? Too many medicines?

Does the person have anyone to help them?

  • Is there someone available to support them? Who?
  • Do they need or want a carer?
  • Does the carer care for someone else? Is the person difficult to care for?
  • Does the carer receive carer’s support assistance or allowance?

2. Results

  • Everyone should:
    • have a safe environment or have the strength and ability to avoid falling
    • have the ability to understand and take their medicines safely
    • be able to self-care, or if unable, have a socially-emotionally and financially supported carer

3. Brief intervention

  • Living independently without support can be difficult. Ensure patient is registered with My Aged Care services. See Resource 1.
  • As people age they become less able to perform daily tasks including managing
    finances or medicines, moving safely, dressing, toileting and eating
  • Always assess general safety at home, especially for risks associated with falling e.g. trip hazards from mats, uneven surfaces, steps
  • Always encourage Diet and nutrition, and Physical activity and sleep
  •  
  1. Self-care 1
    • Being unable to self-care is associated with falls, frailty and undernourishment. Consider Dementia as a cause
    • Regular assessment of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) can identify health and safety requirements. See Table 2.
    • For those struggling with IADLs consider Advance Care Planning to assist with a persons wishes for long term care

Table 2. ADL versus IADL 2

Activities of Daily Living

Instrumental Activities of Daily Living

Basic self-care tasks:

  • Getting in and out of bed
  • Eating meals
  • Going to the toilet
  • Showering or bathing
  • Dressing

Tasks requiring complex thinking and organisational skills:

  • Household cleaning and maintenance
  • Shopping
  • Preparing meals
  • Managing finances
  • Arranging appointments
  • Taking medicines
  1. Falls 1–3
    • Knowing an individual’s risk of falling provides opportunities to prevent them occurring by identifying a person’s physical ability and their home environment
    • Screen for individual falls risk. See Resource 2.
    • Review medicines and minimise sedatives especially benzodiazepines
    • A balance and strength group assists with gross motor stability and co-ordination
    • A home assessment identifies modifications required to minimise slips and falls
  2. Medication safety 1–3
    • Medication safety ensures a person avoids overdosing, falls, polypharmacy (taking > 5 medicines), cognitive impairment and complacency
    • Simplify medication access using blister/webster packs, electronic dispensers or provide medication prompting (by clinician, carer or third party service)
    • Ensure an accredited pharmacist provides a home medicines review and the person’s response to them. See Resource 3.
  3. Carer support 1–3
  • Discuss care options, involving family in the process if appropriate
  • Caring for someone can be a source of burden, stress, isolation or abuse, especially if the person has become violent or agitated
  • Assess and address the needs of the carer. See Engaging our patients
  • Provide emotional and practical support services for carers to address their own needs. See Resources 4.
  • Involve carers in all service co-ordination and interventions including education, visiting specialists, and telehealth, telephone or online service provision

4. Referral

  • Refer to:
    • MO/NP for further assessment if self-care appears compromised. See Cognition and recall, Dementia
    • occupational therapist for falls risk assessment and home modifications. See Resource 2.
    • physiotherapist or exercise physiologist for strength and balance group
    • local pharmacist for Home Medicines Review services to rationalise safe patient medicines use
    • respite and carer support services for carers. See Resource 4–5.
    • patient cleaning, assistive aids or support care services. See Resource 6.

5. Follow-up

  • Place the person on a recall register if required
  • Ensure all referrals are actioned
  • Provide the person with details for the next scheduled follow-up appointment

6. References

7. Resources

  1. My Aged Care services
  2. Individual falls risk screening
  3. Home Medicines Review
  4. Carers Australia and Carer Gateway
  5. Respite services
  6. myagedcare and Medical Aids Subsidy Scheme (MASS)

Last updated: September 2024

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