Aims

1. Identify signs of early Functional Decline (FD) articulated as important by community-dwelling older people, their families and neighbours, primary and sub-acute sector healthcare providers

2. Compare these signs with published literature on early FD, and develop a comprehensive test battery

3. Use the test battery to describe the epidemiology of FD (its trajectory) over 12 months, for older individuals living independently in the community at time of recruitment

4. Develop an early warning system of indicators for use by primary and sub-acute healthcare sectors, to assist in identifying early FD in community-dwelling older people;

5. Incorporate the above into a blueprint for integrating early FD identification across primary and subacute healthcare sectors, which will assist policy-makers, administrators, clinicians and service providers to be:

a. proactive in meeting the challenge of supporting older community-dwelling Australians on the cusp of FD to remain safe, and independent at home

b. prepared to prevent unnecessary use of expensive tertiary sector and residential care.

Synopsis

Functional Decline (FD) is the loss of ability to live independently and safely in the community. FD reflects increasing physical, social and cognitive frailty, and it is known that age alone is not a good FD predictor.

Current detection of FD is too late (as it mostly occurs in hospitals after a health crisis, when the older person is unwell and out of their familiar environment). This leads to a real opportunity for error both in assessment/measurement of FD, and provision of appropriate services.

The current 75+health assessment is underutilised.  This is occurring in an environment where there have been significant changes in the politics and practicalities of screening programs for older people in primary care settings, especially that there is also uncertainty regarding continuing funding for many primary care screening initiatives.

Studies investigating the impact of preventative screening of the elderly have found that while one-off assessments such as the 75+ Health Assessment doesn’t seem to prolong life, they do appear to do what the elderly want, which is minimise falls, admissions to acute hospitals and maximise opportunities to stay in their own homes.

This project will partner with local GPs and their practice nurses, the peak consumer body in South Australia (Health Consumers Alliance) and Medicare Locals to explore the practical way of incorporating a more sensitive assessment of FD into the current Medicare-funded 75+ health assessment tool. It is hoped that the evidence will inform practice and policy to enhance the usefulness of the current 75+ health assessment Medicare item.