Problems of functional status in the elderly

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Why . increased life expectancy has made the health of the elderly an issue of concern in most countries. Changes in society also make the social isolation of the elderly a problem not restricted to the industrialized world . the elderly are vulnerable, and it should be possible to design appropriate ways of promoting an optimum quality of life for the elderly in a primary health care context . screening for cataracts, a common and treatable cause of blindness in the elderly , addressed below.
How , a recent essay aimed at general practitioners in the united kingdom urges that screening (of the elderly ) should be oriented to the patient s functioning and not to disease (freer, 1990). Periodic assessment is recommended, including  assessment of mobility, social and mental functioning, hearing, vision, and continence, and a review of medication, the author also recommends an annual home visit. The USPSTF (1989)has stressed assessment of functional status as an essential component of preventive care for the elderly.
It appears worth while to train primary care workers to make routine functional assessments of elderly persons in the community, especially those with precarious social support . the goal would not be to detect disease but to detect functional limitations that could be relieved with simple measures within the reach of local resources and to promote maximal functional status (WHO< 1989b) . simple multidimensional assessment  tools and  interventions that could be used by primary care workers need to be develop and validated (Cooper & Bickel, 1984; fillenbaum, 1985; beers et al ,. 1991).
Resource levels required. Low for screening by primary care worker; low or medium for definitive diagnosis and for intervention, including simple supportive social interventions.
Recommendation on use of screening, screening of the elderly for functional status is recommended as a priority, along with early detection of diminished mental or physical function.

Research priority. Developing simple but accurate assessment tools that can be used by primary care workers, together with ways of training primary care workers to deal effectively with the risks detected (tertiary prevention).

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