Measuring functional ability in hospitalized older adults : A validation study

Purpose: To examine the internal consistency, construct validity and responsiveness of functional assessments tools when used with hospitalized older adults.

Materials and methods: The functional ability of 66 patients was assessed using a semi-structured interview scale (n = 16 tools). The assessment of motor and process skills was administered during hospital admission and again at three months post-discharge.

Results: Tools showed poor-to-excellent internal consistency (α = 0.27–0.92). Of the tools that were internally consistent, only two demonstrated change: the Groningen activity restriction scale (GARS) (smallest detectable change [SDC] 11.68, effect size −1.59) and the modified reintegration to normal living scale (SDC 7.04, effect size −1.20). Validity was supported by strong correlations between the functional independence measure™ (FIM™) and the GARS, FIM™ and Sunnaas activity daily living (ADL) index.

Conclusions: Findings suggest that the GARS and the modified reintegration to normal living index (mRNLI) are internally consistent, valid and responsive to change over time when applied to a sample of hospitalized older adults. Further investigation of these tools in terms of inter and intra rater reliability in clinical practice is warranted.

Implications for Rehabilitation
• Therapists and researchers need to choose standardized functional assessments carefully when working with hospitalized older adults, as not all assessments are reliable and valid in this population.

• The GARS and mRNLI are valid and responsive functional assessments for hospitalized older adults.

• Activity and participation have been viewed traditionally as only one component of function. Therapists and researchers can use standardized assessments of function that are activity or participation-based.

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