Multidimensional Functional Assessment

Historical Development of MFA

MFA first began in the United Kingdom in the 1930s and 1940s with the work of the pioneering geriatrician, Marjory Warren. By using MFA, she was able to rehabilitate and return to the community a large proportion of patients who had been confined to bed and institutionalized. In the mid-1970s, increasing awareness of geriatric care in the United States precipitated the creation of the Geriatric Research, Education and Clinical Centers (GRECC) within the Veterans Health Administration. The GRECCs were established to integrate research, education, and clinical achievements in geriatrics into the Veterans Affairs (VA) Health Care System. An early focus of their research and clinical practice was comprehensive geriatric assessment, which incorporated MFA into a medical evaluation and led to the establishment of geriatric evaluation and management (GEM) units, first in the hospital setting and later in the outpatient setting. In subsequent years through the 1990s, these and many other inpatient and outpatient comprehensive geriatric assessment programs were analyzed in multiple single-site randomized controlled trials. By the mid-1990s, enthusiasm for the clinical model resulted in multisite trials, as described in a later section.

MFA Methodology and Goals

MFA uses a variety of standardized instruments, often administered in a structured interview or questionnaire, which assesses the pertinent dimensions of patient health. The end result is not so much a diagnosis as an indication of the areas in which there are impairments. Physical functioning is usually assessed by measuring ADLs and IADLs. Basic ADLs are the self-care activities of bathing, dressing, toileting, transferring, continence, feeding, walking, grooming, and climbing stairs, while IADLs include the ability to use the telephone, travel, shop, prepare meals, do housework, do laundry, take medicine, and manage personal finances. Mental health assessment includes cognitive functioning and psychiatric diagnoses or symptomatology (i.e., mood and depression testing), with the frequent inclusion of life satisfaction and a mental health self-assessment. Physical health usually entails an assessment of comorbid medical conditions or symptom lists and their severity, prescribed medications, the receipt of medical services such as doctor or hospital visits, and nutrition-related topics. A subjective measure of physical health is often included. Social functioning includes the quantity and quality of support received and needed from family and friends. Again, objective and subjective information is usually sought. Economic functioning measures the adequacy of income.

MFA is a useful tool in a number of situations. It can be used to characterize individual patients for clinicians or an entire population for epidemiologists or program planners. For the individual clinician and patient, MFA is intended to identify the care needs, create a plan of care, and ultimately improve outcomes. The process is most effective in frail older adults who do not have a poor prognosis; [Page 732]older adults with good baseline functional status and those with a poor prognosis are either too well or too sick to benefit. The major goals are to diagnose and treat medical conditions when possible, improve functional status and quality of life, and optimize service use and the living situation. Classification in terms of functional capacity rather than a list of diagnoses is more helpful in the identification of care needs, as a diagnosis does not indicate a care need or personal level of independence. An MFA can also be used as a screening or preventive health program to identify patients who are most likely to benefit from preventive interventions such as fall prevention programs.

...