Skip to main content

What a Gatorade Bottle Taught Me About Functional Assessment



by: Leah B. Rorvig, MD, MS (@GeriPowerMD)

On the third day after my arthroscopic shoulder surgery, I was finally alone at home. My nausea had receded. And I wanted Gatorade. I went to the fridge, pulled out the bottle, and lodged it between my knees. I twisted and twisted with my left hand. I held the lid with a towel. No dice. It wouldn’t budge. Defeated, and still thirsty, I put the bottle back in the fridge. It is still there.

My ADL disability is temporary. I’m in a right arm sling 24 hours a day for the next 6 weeks, during which time I can’t drive or hold anything heavier than a cup of coffee in my right hand. But by next May (6 months from now) my surgeon says I’ll be back to surfing two or three times a week and, best of all, it is very unlikely that I will ever dislocate my right shoulder again (despite my love of sports like surfing and rock climbing). But as a clinical fellow in geriatrics, having a temporary ADL disability has profoundly impacted my perspective on my patients’ functional limitations.

Recently the daughter of a patient of mine (who happens to be in his 90s) told me that he would spend “hours” changing his hearing aid batteries. This gentleman had plenty of support around, and so my immediate response to the patient was “Why don’t you just ask someone to do it for you?” But now that I’ve experienced the shame and frustration of being unable to wash my own dishes—and even my own hair—I can’t believe I would ask such a naïve question so unthinkingly.

Is it necessarily shameful not to be able to wash your own dishes or change your own hearing aid batteries? Of course not. But in our society where self-reliance and independence are core pillars of adulthood, I think I’m not alone in experiencing my own loss of function as a threat to my self-worth.

Curious about what the literature has to say about how we as clinicians should help our patients cope with their declining functional status, I didn’t find much. Yes, I learned that unmet ADL need is associated with all kinds of bad outcomes, including increased risk of hospitalization and even increased mortality. Studies also find that depression in old age is a risk factor for disability, and it is a two-way street - disability is also risk factor for depression. Dissatisfied with what I found, I reached out to one of the leading researchers in my department, and he acknowledged there is very little research on how to manage or improve quality of life among those who already have disability.

What will I do differently as a result of my own unanticipated ADL disability? I’ll stop reflexively minimizing my patients’ functional decline and what it symbolizes. Instead of just asking my patients about their ADL impairments, I now feel I need to also ask about the experience of even having ADL impairments. And then I can begin the real work of understanding what might help those patients who are experiencing distress due to their functional disability. My guess is that it isn’t just an easier to open Gatorade bottle.


Comments

Peg Graham said…
Calling attention to mitigating the impact of functional loss! As you point out, there is so much we don't understand about the interaction of losing the capacity to self-manage basic tasks. My family learned how important self-toileting was to our Mom as she aged with post-polio syndrome. With a bathroom too small to accommodate a wheelchair, she selected transfer board-to-bedside commode as her "next best" option, horrified by the thought of swinging in the air in a Hoyer commode swing, or having her children change a diaper. However, she needed us to help her stabilize the board as she inched along, so even there she needed assistance which we all pretended we weren't doing. Upon her death in 2004, my family began to work on an innovative commode, one with an internal lift and tethered board that promotes full self-management of this toilet option. We are working with the TREAT Center, an NIH-funded engineering lab to commercialize this idea, hoping to attract a manufacturing partner.

We have also run into the scarcity of research into ADLs, their interactions and how relief of one might impact the others, and the overall relationship with depression and quality of lift.

THANK YOU for this post, and we join your call for more research into this question. Given the caregiver gap that will only get worse, knowledge and science about functional independence at the individual ADL level is more important than ever.
Anonymous said…
Thank you for this post. Using my own difficult experiences and chronic health challenges to have deeper understanding of and empathy with patients has been very beneficial - both for my patients and for me.

Popular posts from this blog

Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End."

As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care.  His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times.  As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement.

The book he and Berger wrote is filled to the brim with practical advice.  I mean, nuts and bolts practical advice.  Things like:
How to clean out not only your emotional house but your physical house (turns out there are services for that!)Posting about your illness on social media (should you post to Facebook)What is the difference between a funeral home and mortuaryCan I afford to die?  …

Improving Advance Care Planning for Latinos with Cancer: A Podcast with Fischer and Fink

In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer.  The issue of lay health navigators raises several issues that we discuss, including:
What is a lay health navigator?What do they do?  How are they trained?What do lay health navigators offer that specialized palliative care doesn't?  Are they replacing us?What makes the health navigator intervention particularly appropriate for Latinos and rural individuals?  For advance care planning? Eric and I had fun singing in French (yes French, not Spanish, listen to the podcast to learn why).
Enjoy! -@AlexSmithMD




You can also find us onYoutube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher

Transcript

Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, I'm really excited about toda…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …