Academic journal article Australian Health Review

The Australian 75+ Health Assessment: Could It Detect Early Functional Decline Better?

Academic journal article Australian Health Review

The Australian 75+ Health Assessment: Could It Detect Early Functional Decline Better?

Article excerpt


Functional decline (FD) is a correlate of ageing. Although research has been conducted since the 1940s into the characteristics and predictors of FD, these often focus on established FD and are too late to intervene effectively to ensure the older person is able to stay independent. The increasing lifespan of Australians and expectations of older Australians wanting to live independently in the community demands new insights, and earlier detection, to minimise the burden that FD creates. FD is reported as the most common reason for older individuals to require supports that assist them to retain their independence.1-3 Obtaining a better understanding of early FD could enable proactive early intervention, and slow or even prevent entry intoa trajectory of established FD, positively impacting on the financial and social burden associated with an aging Australia.

FD is considered to occur on a trajectory, with a critical point beyond which decline in function is irreversible.3 Most of the literature deals with established (or difficult to reverse) FD, usually detected when an older person requires urgent medical care for a health crisis.4-6 Established FD is characterised as the loss of capacity to perform one or more activities of daily living (ADL).7-10 ADL refer to everyday tasks (e.g. bathing, dressing, feeding, continence, transferring and toileting), as well as higherlevel activities (e.g. shopping, driving, cooking, banking) and advanced activities (activities of a social nature). This inability to manage ADL independently may be related to illness and some function may return with better health, but in most cases it is difficult toreverse andusually results intheolder person notbeing able to remain at home safely and independently.

Research in the past decade has established that loss of capacity for ADL is usually preceded by, or associated with, multiple factors related to the aging journey, such as depression, loneliness and/or anxiety, compromised nutrition and sleep patterns,confusion,aswellasreducedphysicalactivity, musclemass and strength and outside interests.3,7,8,10,11 Managing the ramifications of established FD is associated with high healthcare costs and increased rates of health service use, institutionalisation and mortality.7,12 Established FD is also associated with the potential for further deconditioning when an older person is admitted to hospital.13 Deconditioning subsequent to established FD is expensive and complex to reverse, and is often the reason why older people are discharged from hospital to aged residential care rather than to their own homes.14,15

Given the predicted increases within the next decade of the Australian lifespan and the number of older Australians living independently in the community,16 it is critical to understand how best to assist older people to remain at home as safely and independentlyas possiblefor aslong astheychoose.Thefinancial and social ramifications of not doing this are immense; there have already been concerning estimates of the huge and escalating burden that will be placed on Australian healthcare in the next decade by the sequelae of unmanaged FD.17

The logical place to start is to obtain a better understanding of early FD in a way that could allow effective early intervention and prevent what may otherwise be entry to an inevitable trajectory of established FD.11,18 In Australia, a health assessment for people aged 75+ years (Medicare 75+ Health Assessment (75+HA))19 is a primary care Medicare initiative that could be capitalised on to allow identification of early FD. The purpose of the 75+HA is to:

...identify risk factors for FD in elderly people, that may require preventative or remedial health management. In addition to assessing a person's health status, a health assessment is used to identify a broad range of factors that influence an older person's physical, psychological and social functioning.20

The assessment consists of measures of health and physical, psychological and social function with four Medicare item numbers reflecting the length and complexity of the consultation: 701 (brief), 703 (standard), 705 (long) or 707 (prolonged). …

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