Geriatric functional assessment in acute care: a pilot project.

This experimental pilot project examined 33 acute care patients over age 70 to determine if length of stay, cost of stay, and functional decline during hospitalization could be reduced through early assessment. A gerontological clinical nurse specialist (GCNS), using three established instruments, scored all patients within 72 hours of admission to the study unit in relation to mental status, physical functioning, and ability to perform activities of daily living. The instruments included the (a) Mini-Mental State Exam (MMSE), (b) PULSES Profile, and (c) Katz Index of Activities of Daily Living (Katz ADL). The GCNS's assessments and recommendations for care were documented in patient charts. Subjects were randomly assigned to experimental or control groups. Those in the experimental group received GCNS monitoring, which included daily (except weekends) patient visits to assess newly developed problems, response to interventions, and follow-through on previous recommendations. Other patients received only the usual care. Subjects were retested prior to discharge. The differences between change scores from admission to discharge were not statistically significant. However, the GCNS observed several positive trends in medical and nursing staff practices in relation to increased staff awareness of geriatric care needs. Replication of this study using a larger sample of high-risk elderly patients is needed to further delineate the potential benefits of the unit-based model.