Warning Signs along the Road to Functional Dependency

In the general community-dwelling population of older persons, dependence in basic self-care tasks, the “activities of daily living” (ADL), is uncommon. According to most studies, fewer than 10% of these persons need assistance with such tasks as bathing, dressing, transferring from bed to chair, feeding, grooming, and using a toilet [1]. Nevertheless, older persons with such functional dependency incur high health care costs [2]. Older persons with ADL dependency are also costly to society in other respects; for example, they place a burden on their families, who must use personal resources and often relinquish other responsibilities to care for them.

The road to ADL disability for older persons generally follows one of two paths. The first is characterized by catastrophic events that strike previously healthy persons and quickly leave them temporarily or permanently dependent. Such dependency often occurs after a traumatic event (such as hip fracture), an acute medical illness (such as a stroke), or a surgical procedure with serious complications. For physicians, the key to preventing this route to disability is the conscientious practice of preventive medicine that addresses risk factors for these calamities and minimizes the complications (sometimes iatrogenic) of acute medical and surgical illness.

The second …