Functional Independence Measure (FIM™)
The FIM is a functional assessment measure widely used in the rehabilitation community. It is based on an 18-item ordinal scale, used with all diagnoses encountered in the rehab population and can also be used to assess patient’s progress during treatment. The FIM™ has become proprietary and the current owners of have decided that the acronym FIM(TM) no longer stands for Functional Independence Measure and should be referred to only as FIM(TM). This web site provides additional information about the instrument.
Outcome and Assessment Information Set (OASIS)
OASIS is a comprehensive assessment for adult home care patients and forms the basis for measuring patient outcomes for purposes of outcome-based quality improvement. OASIS is a required component of the Conditions of Participation for Medicare-certified home health agencies. The web site includes an overview of CMS’s Home Health Quality Initiatives, including OASIS.
Skilled Nursing Facilities
The Minimum Data Set (MDS)
The MDS is a standardized tool for assessing functional capacity of residents in long-term care facilities. The MDS includes questions related to medical conditions, physical function, cognitive patterns, psychosocial well-being, communication, hearing, vision, and mood and behavior patterns. It provides the basis for individualized care planning, reimbursement from Centers for Medicare and Medicaid Services (CMS), and the quality indicators and measures in nursing facilities. The site includes an overview of CMS’s Nursing Home Quality Initiatives, including the MDS.
The Vulnerable Elders Survey (VES),
This survey was developed by the Rand Corporation and is a “simple function-based tool for screening community-dwelling populations to identify elderly persons at risk for health deterioration. The VES considers age, self-rated health, limitations in physical function, and functional disabilities.” An overview of the development of the VES as well as the survey and scoring guide can be found on the web site.
The Try This® and the How to Try This
This series from the Hartford Institute for Geriatric Nursing provide summaries of evidence-based assessment tools as well as videos demonstrating how to administer the assessments. Topics include:
- Activities of daily living
- Mental status
- Pressure ulcers
- Fall risk
- Urinary incontinence
- Caregiver strain
- Elder abuse/mistreatment
- Inappropriate medications
- Alcohol use
- Oral health
The Folstein Mini-Mental State Examination (MMSE)
This tool is used to screen and estimate the severity of cognitive impairment, follow the progression of disease, and document response to therapy. The MMSE is currently published and sold by Par at www.minimental.com .
The Constipation Assessment Scale is a brief tool to initially screen patients for bowel issues. It is not intended to supply a definitive diagnosis of constipation but to provide insight into symptoms of constipation experienced by the patient.
McMillan SC, Williams F. Validity and reliability of the constipation assessment scale. Cancer Nurs. 1989; 12(3): 183-188.
The Tinetti Performance-Oriented Mobility Assessment (POMA)
This assessment consists of two evaluations measuring gait and balance. The POMA has been shown to be a good predictor of fall likelihood.
- Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society. 1986;34(2):119-126.
- Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. American Journal of Medicine. 1986;80(3):429-434.
The Get Up and Go Test
This is a brief assessment is used to detect people at risk for falls and to identify those who require further evaluation.
Timed Get Up and Go Test
This test can be particularly helpful in screening people at risk for falls. .
Read about the Timed Get Up and Go Test in:
- Mathias S, Nayak USL, Isaacs B. Balance in the elderly patient ”The Get Up and Go” test. Archives of Physical Medicine and Rehabilitation. 1986; 67:387-389.
- Podsiadlo D, Richardson S. The timed "Up and Go": A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society. 1991;39:142-148.
While a specific diagnosis is obtained with an audiometer, various screening methods can be used as preliminary evaluation tools. Not only should problems during conversation be noted, but the patient should also routinely be asked about hearing dysfunction.
The Whisper Test
The Whisper Test entails standing behind the patient, two feet from the ear, covering the untested ear, whispering an easily answered question, and evaluating the response.
The Brief Hearing Loss Screener (Requires free registration)
This tool consists of seven questions with varying points assigned to different answers. A score of three or more is indicative of a need for further evaluation.
The DETERMINE Checklist
This check list was developed by the Nutrition Screening Initiative, can be answered by a patient, non-licensed health professional, or healthcare professional. The accompanying acronym can also be used to remember the warning signs for malnutrition: Disease, Eating poorly, Tooth loss/mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss/gain, Needs assistance in self-care, Elder years above age 80.
Pain assessment tools include visual pain “scales” that prove useful when assessing pain in a patient with limited communication skills or cognitive impairment. The most common assessment tool is the numerical Visual Analog Scale. The patient is asked to rate their pain on a scale of 1 to 10.
The Wong-Baker FACES Pain Rating Scale
The Wong-Baker FACES Pain Rating Scale consists of six “faces” ranging from happy to grimacing to characterize various grades of pain, and the Pain Thermometer gauges levels of pain through comparison with varying temperatures.
Read about pain scales in:
- Wong-Baker FACES Pain Rating Scale. Wong DL, Hockenberry-Eaton M, Wilson D, Winkelstein ML, Ahmann E, DiVito-Thomas PA: Whaley and Wong’s Nursing Care of Infants and Children, ed: 6, St. Louis, 1999, Mosby, p.1153.
- “Pain Thermometer.” Report of the American Geriatrics Society Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. Journal of the American Geriatric Society. 2002;50:S205-S224.
The Brief Pain Inventory (Short Form)
This inventory allows for documentation of specific descriptions of the pain, interferences in activities, and the value of pain treatment(s). Brief Pain Inventory (Short Form). Developed by the Pain Research Group; Charles Cleeland, PhD; 1991. Geriatrics at Your Fingertips, published by the American Geriatrics Society, 2005.