Activity 6: Assessing & maintaining function

People with life-limiting illnesses may experience a decline in their physical and social function. This can occur over the course of their illness trajectory.

As a health care professional, assessing and maintaining a person's function is important to ensure quality of life is optimised. In palliative care, even the smallest improvements in functional status may be viewed very positively by the patient.

What is functional status?

A person's functional status comprises several dimensions, including:

• cognitive functioning, for example attention, concentration, memory and problem solving
• behavioural functioning, for example undertaking daily activities, such as bathing, dressing, feeding, as well as instrumental activities, such as shopping, cooking and cleaning
• psychological functioning, for example mood, affect, and motivation
• social functioning, for example activities associated with roles at various stages of development.

Assessing functional status

Both clinician assessment and an individual's self-report can be used to assess the patient's functional status. The Australian modified Karnofsky Performance Status (AKPS) scale is one assessment tool that is used by clinicians to assess individual's performance status. [1]

In selecting a tool for assessing function, it's important that the tool chosen is relevant to the person's care goals. This means that it's important you understand:

• the person's preferences and goals in relation to their function
• the trajectory of a person's illness, and the anticipated progression of their clinical problems.

Once goals of care are identified, consider the following questions to guide your selection of a method for assessing function that is relevant to the person's goals of care.

• Does the assessment method measure cognitive, behavioural, psychological, or social aspects of function?
• Is this assessment consistent with the person's own goals?
• Does the assessment method require the person's self-report, or can it be generated by a proxy (caregiver or clinician)?
• Is the assessment method practical and feasible for this person's circumstances?
• Is the assessment method sensitive enough to pick up changes in a person's function?

Thinking points

REFERENCES

1. Abernethy, A., Shelby-James, T., Fazekasm B., Woods, D., Currow, D. (2005). The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice. BMC Palliative Care, 4(7). Retrieved September 15, 2010, from http://www.biomedcentral.com/1472-684X/4/7