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Questions and simple tests for general screening assessment of frail older patients*

Questions and simple tests for general screening assessment of frail older patients*
  Question Indicator
(scoring applies to individual domains)		 Alternative
Functional status
Activities of daily living (ADLs) Bathing, dressing, toileting, transferring, maintaining continence, feeding Able to complete without assistance; able but with difficulty; unable to complete without assistance  
Instrumental ADLs (IADLs) Using the telephone, shopping, preparing meals, housekeeping, doing laundry, using public transportation or driving, taking medication, handling finances Able to complete without assistance; unable to complete without assistance  
Visual impairment
  Do you have difficulty driving, watching television, reading, or doing any of your daily activities because of your eyesight, even while wearing glasses?[1] Yes indicates positive screen Snellen eye chart
Hearing impairment
  Is your age older than 70 years? 1 point Alternative is Audioscope[2]
Are you of male gender? 1 point
Do you have 12 or fewer years of education? 1 point
Did you ever see a doctor about trouble hearing? 2 points
Without a hearing aid, can you usually hear and understand what a person says without seeing his face if that person whispers to you from across the room? If no, 1 point
Without a hearing aid, can you usually hear and understand what a person says without seeing his face if that person talks in a normal voice to you from across the room? If no, 2 points
  ≥3 points: positive screen
Urinary incontinenceΔ
  Have you had urinary incontinence (lose your urine) that is bothersome enough that you would like to know how it could be treated? Yes indicates positive screen  
Malnutrition
  Have you lost any weight in the last year?[3] Loss of at least 5% of usual body weight in last year indicates positive screen[3]  
Gait, balance, fallsΔ
  Have you fallen two or more times in the past 12 months? Any yes response indicates positive screen  
Have you fallen and hurt yourself since your last doctor's visit?
Have you been afraid of falling because of balance or walking problems?
Depression◊
  Over the past two weeks, how often have you been bothered by: Response score for each:
  • 0: not at all
  • 1: several days
  • 2: more than half the days
  • 3: nearly every day

Total ≥3 points: positive screen

  
Little interest or pleasure in doing things?
Feeling down, depressed, or hopeless?
Cognitive problems
  Three-item recall[4] <2 items recalled indicates positive screen[4]  
Clock-drawing test[5] Any of the following errors indicate positive screen: wrong time, no hands, missing numbers, number substitutions, repetition, refusal[5]
Environmental problems
  Home safety checklists[6]    

* All except the Snellen eye chart, Audioscope, and evaluation for cognitive problems can be assessed by self-report using questionnaire.

¶ Questions and response indicators are from the National Health and Nutrition Examination Survey (NHANES) battery.[7]

Δ Questions and response indicators are from the ACOVE-2 Screener.[8]

◊ Questions and response indicators are from the Patient Health Questionnaire-2.[9]
References:
  1. Moore AA, Siu AL. Screening for common problems in ambulatory elderly. Am J Med 1996; 100:438.
  2. Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care. JAMA 2003; 289:1976.
  3. Wallace JI, Schwartz RS, LaCroix AZ, Uhlmann RF, Pearlman RA. Involuntary weight loss in older outpatients. J Am Geriatr Soc 1995; 43:329.
  4. Siu AL. Screening for dementia and investigating its causes. Ann Intern Med 1991; 115:122.
  5. Lessig MC, Scanlan JM, Nazemi H, Borson S. Time that tells: critical clockdrawing errors for dementia screening. Int Psychogeriatr 2008; 20:459.
  6. Centers for Disease Control and Prevention; National Center for Injury Prevention and Control. Check for safety: A Home Fall Prevention Checklist for Older Adults. Available at: https://www.cdc.gov/steadi/pdf/check_for_safety_brochure-a.pdf (Accessed on June 18, 2020).
  7. Reuben DB, Walsh K, Moore AA, et al. Hearing loss in community-dwelling older persons. J Am Geriatr Soc 1998; 46:1008.
  8. Wenger NS, Roth CP, Shekelle PG, et al. Practice-based intervention to improve primary care for falls, urinary incontinence and dementia. J Am Geriatr Soc 2009; 57:547.
  9. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2. Med Care 2003; 41:1284.

Reproduced with permission from: Reuben DB. Medical care for the final years of life: "When you're 83, it's not going to be 20 years." JAMA 2009; 302:2686. Copyright © 2009 American Medical Association. All rights reserved.

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