Background:The detection of incipient functional decline in elderly persons is not an easy task. Here, we proposethe self-reporting Functional Ability Index (FA index) suitable to screen functional competence in senior citizens in thecommunity setting. Its prognostic validity was investigated in the Longitudinal Urban Cohort Ageing Study (LUCAS).
Methods:This index is based equally on both, resources and risks/functional restrictions which precede ADLlimitations. Since 2001, the FA index was tested in the LUCAS cohort without any ADL restrictions at baseline(n = 1,679), and followed up by repeated questionnaires in Hamburg, Germany.
Results:Applying the index, 1,022 LUCAS participants were initially classified as Robust (60.9%), 220 as postRobust(13.1%), 172 as preFrail (10.2%) and 265 as Frail (15.8%). This classification correlated with self-reported health, chronicpain and depressive mood (rank correlations 0.42, 0.26, 0.21; all p < .0001). Survival analyses showed significantdifferences between these classes as determined by the FA index: the initially Robust survived longest, the Frail shortest(p < .0001). Analyses of the time to need of nursing care revealed similar results. Significant differences persisted afteradjustment for age, sex and self-reported health.
Conclusions:Disability free lifetime and its development over time are important topics in public health. In thiscontext, the FA index presented here provides answers to two questions. First, how to screen the heterogeneouspopulation of community-dwelling senior citizens, i.e. for their functional ability/competence, and second, how far awaythey are from disability/dependency. Furthermore, the index provides a tool to address the urgent question whetherincipient functional decline/incipient frailty can be recognized early to be influenced positively.The FA index predicted change in functional status, future need of nursing care, and mortality in an unselectedpopulation of community-dwelling seniors. It implies an operational specification of the classification into Robust,postRobust, preFrail and Frail. Based on a self-administered questionnaire, the FA index allows easy screening of elderlypersons for declining functional competence. Thereby, incipient functional decline is recognized, e.g. in GPs'practicesand senior community health centers, to initiate early appropriate preventive action.