Functional assessment of older patients in the emergency department: comparison between standard instruments, medical records and physicians' perceptions

Cross-sectional study on 101 frail older patients selected at random from among those attending ED, their ED physicians, and respondents. The study was conducted at ED in four general university teaching hospitals in a city, from July through November 2003. Functional data shown on patients' medical records were compared against functional data obtained from respondents (family members), using Kendall's Tau-b statistic. In addition patients' Katz Indices (which assesses six basic activities of daily living – basic ADL) based on interviews with ED physicians were compared against those obtained from respondents, using the coefficient of concordance weighted kappa (κ). Each patient and his respondent were paired with a single physician.The correlation between information on dependence for basic ADL obtained from medical records and that furnished by respondents, was 0.41 (95% CI 0.27–0.55). Concordance between the respective Katz Indices obtained from physicians and respondents was 0.47 (95% CI 0.38–0.57).Older subjects' functional status is not properly assessed by emergency department physicians.Emergency departments (ED) are used more frequently by older people than by the general population [1] and are not adequately prepared to attend to senior citizens' needs, which differ from those of the younger population [2].Comprehensive geriatric assessment detects problems that traditional medical records tend to overlook [3,4]. One such problem is functional impairment and the dependence that ensues, a factor closely related to mortality among older people [5,6].During older patients' visits to the emergency department, geriatric problems or risk factors for developing functional disability might be detected [7-10], and short-form assessment instruments requiring little implementation time have in fact been proposed for this purpose [11]. However, emergency department patients are known to be seldom questioned about their selfcare ability [12]. Consequently, functional