How To Notice Signs of Functional Decline in Older Adults

As we age, we may go through physical and emotional changes that affect our ability to take care of ourselves and maintain our independence. These changes can be gradual or sudden, depending on the cause.

We tend to notice sudden changes, but gradual changes may not be noticed until support is needed from our family, friends, or caregivers for daily activities. Functional decline is not a normal process of aging and should be evaluated when it happens to see if there are causes that can be addressed. 

What Is Functional Decline in Older Adults? 

Functional decline is defined as a new loss of physical or cognitive functions that impacts the ability to participate in ADLs (activities of daily living) or IADLs (instrumental activities of daily living). Activities of daily living are essential for daily living and include self-care tasks such as:

• Feeding oneself 
• Controlling bladder and bowel function 
• Dressing 
• Walking 
• Toileting 
• Personal hygiene

Instrumental activities of daily living allow a person to live at home or in the community independently, such as: 

• Managing finances 
• Using transportation 
• Shopping 
• Housekeeping 
• Doing laundry
• Using the telephone 
• Managing medications
• Preparing meals

People may have an acute illness or event such as a fall which leads to functional disability. Worsening or new onset of some chronic diseases can also cause functional decline, including: 

• Dementia 
• Arthritis 
• Parkinson’s disease 
• Diabetes mellitus 
• Obesity 
• Cancer 
• Heart disease 

Functional decline affects an individual’s independence and makes them more vulnerable to injuries and certain health conditions unless the causes are detected and addressed, or help is provided. 

How To Notice Functional Decline: A Step-By-Step Guide 

Observe and Track Changes 

The first step is to observe and make note of any significant physical or mental changes in ourselves or the person we are supporting. One approach is to keep a notebook or a file in which we can write down details about these changes. It is often useful to make different sections in the notebook, including such things as vital signs (e.g., blood pressure, heart rate, breathing rate, temperature), medication use, signs of health changes, and any changes in diet or activity. Be sure to include dates.

Look for Symptoms and Red Flags 

The next step is to watch for any signs of decline in physical or mental abilities. Pay attention to whether you or the person being supported needs help with the everyday tasks listed above or is showing the symptoms listed below:  

Symptoms of Physical Decline 

• Reduced mobility or changes/difficulty in body movements
• Posture changes
• Poor balance 
• Reduced body strength or lack of stamina
• Difficulty breathing 
• Increased falls or injuries 
• Difficulty in carrying out personal tasks without assistance

Symptoms of Cognitive Decline  

• Memory problems or difficulty in remembering recent events
• Difficulty in communication or mixing up words
• Irritability or aggression 
• Mood changes 
• Disturbance in focus or concentration abilities.
• Difficulty in making decisions 
• Poor judgment 
• Difficulty in finding the way, even in familiar environments or places
• Changes in eating habits  

Consult a Healthcare Professional 

Consulting a healthcare professional is the next important step. Bring your health journal or notebook with you so you can provide accurate answers and write down what your healthcare professional recommends. It is very important to find out whether there is an acute illness, such as a urinary tract infection, or a  chronic condition, such as heart failure, causing the physical or mental decline in a person. These conditions often require treatment and medications. 

For example, memory loss can occur because of medication side effects, dementia or a stroke. Medications or other treatment may be necessary to improve the condition or perhaps prevent it from getting worse. 

Another example is difficulty with getting up from a chair and walking, which may result from arthritis or back problems. Regular physical activity or therapy may help improve mobility and reduce functional decline.

Studies show that awareness of medical conditions that can lead to physical or mental decline and appropriate intervention help prevent or delay functional decline and disability.

How To Reduce or Cope With Functional Decline

The following measures can be taken to help older adults cope with functional decline: 

• Use of assistive devices where needed, like a walker, cane, wheelchair, or hearing aids
• Installing necessary home improvements, like handrails, elevated toilet seats, efficient lighting, medical alert systems, or others
• Encouraging regular mild to moderate physical and mental activity
• Ensuring a healthy and balanced diet
• Increasing social engagement with friends, families, or community centers
• Periodic health checkups 

Plan and Schedule Periodic Checkups 

Older adults are more vulnerable to physical and mental decline due to the increased likelihood of medical illness as we age. Keeping active, both mentally and physically, can help to prevent this from happening. It is important to plan and schedule periodic physical and cognitive health checkups to identify if any adjustments are needed in the treatment or medications to address functional decline.

References:

1. Activities of Daily Living. StatPearls. Accessed October 3, 2024. https://www.ncbi.nlm.nih.gov/books/NBK470404/