400
S. Gordon et al.
matched with the Creditor HAD elements (12) as well as with
items with similar intent in the other included instruments, and
time-frames of reporting were described. Items that were readily
applicable by any healthcare provider, and which could form the
basis of a comprehensive assessment for HAD were identified
by discussion between the authors.
RESULTS
Literature search
Of 1,162 potentially-relevant papers, 8 were retai-
ned, each reporting on the development of a relevant
HAD-assessment instrument (25–32). The inclusion
flowchart is shown in Fig. 1.
As hypothesized, no single instrument reported items
that comprehensively assessed all HAD elements (as
described by Creditor (12)). The 8 identified instru-
ments assessed different elements of HAD, often using
different methods for the same element. The included
instruments are described below.
Timed Up and Go Test (TUG) (25). This point-in-time
assessment reports the time (in s) taken to complete an
integrated task set (rising from a chair, walking 3 m,
turning, walking back, and sitting down again). The
TUG has been used to assess performance in older pe-
ople for 30+ years. It offers a simple way of assessing
complex constructs (transferring between positions,
static and dynamic balance, gait, falls likelihood, and
ability to safely complete turning movements).
Physical Performance Test (PPT) (26). This point-in-
time assessment includes 8 activities of daily living
Articles identified
n = 1,162
Retained after removal
of duplicates
n = 815
Shortlisted after screening
title and abstract
n = 308
Included as potentially
relevant to topic
n = 57
General screening for
deconditioning
n = 8
Duplicates
n = 347
Excluded as not relevant on
title and abstract screening
n = 507
Excluded as not relevant on full text
screening n = 226 including
•
n = 26 interventions for
deconditioning or frailty
•
n = 25 screening/assessment
instruments for functional
decline or frailty
Background material n = 22
Causality of deconditioning /
frailty n = 27
Fig. 1. Literature inclusion flow chart.
www.medicaljournals.se/jrm
(writing a sentence; simulated eating; turning 360°;
putting on and removing a jacket; lifting a book and
putting it on a shelf; picking up a coin from the floor;
walking 50 feet; and climbing stairs (optional)). The
PPT has been widely used in aged care settings.
Dartmouth COOP (Cooperative) Function Charts
(27). This instrument is over 30 years old. It is pub-
lished in association with the World Organization of
Colleges, Academies and Academic Associations of
General Practitioners/Family Physicians (WONCA)).
It measures 6 aspects of function over the previous
4 weeks (physical fitness, feelings, daily activities,
social activities, change in health, and overall health).
A pain measure is optional, and a sleep measure is
being developed. Each chart uses a simple drawing
and 5-point ordinal response scales (“no limitation at
all” to “severely limited”). The instrument has been
translated into 17 languages, and is widely used in
research and clinical practice. It requires registration
prior to use.
Nutrition Screening Initiative Checklist (NSIC) (28).
This consensus-based instrument assesses nutritional
risk in older people, using a “recent” reflection period
(undefined). It can be delivered via telephone inter-
view, or face-to-face. Higher scores identify increased
nutritional risk. It measures dietary intake and recent
dietary changes, dental and oral health, swallowing,
social isolation, expenditure on food, polypharmacy,
recent weight loss or gain, and compromised functional
capacity in shopping or cooking.
Short Physical Performance Battery (SPPB) (29). This
point-in-time instrument captures ability to overcome
daily movement challenges including standing and
sitting 5 times from a chair, balance and walking a
set distance.
Mini Nutritional Assessment (MNA) (30). This mul-
tidimensional instrument evaluates nutritional state
and risk in elderly people. It includes point-in-time
anthropometric measures (weight, height, arm and calf
circumferences, weight loss), and current medications.
It also includes questions with a longer (3-month) re-
flective period on lifestyle, mobility, diet and subjective
self-assessed health and nutritional state. The point-in-
time questions are relevant to repeated delivery during
an acute hospital stay. Respondents are classified on a
total score as “normal and well nourished”, or “at risk
for malnutrition”, or “malnourished”.
De Morton Mobility Index (DEMMI) (31). This is a
point-in-time measure of mobility using increasingly
difficult physical challenges. DEMMI has been tested
in different clinical settings and older populations. It
has 15 items measuring mobility in bed, in a chair,