Although realizing major improvements in the older adult's functional abilities may not be possible, even minor changes may significantly improve the individual's quality of life. For example, regaining the ability to move from the bed to the chair or the chair to the toilet may mean the difference between returning home or being institutionalized. Or, independence in feeding can be made possible by regaining the ability to oppose the thumb to the other fingers. Functional status is closely interrelated to the older adult's medical, emotional and cognitive health. The presence of disease can hinder the person's ability to perform everyday tasks, and the inability to perform those tasks can cause emotional distress.
Cognitive impairment can interfere with functional performance.
Assessment of the person's mental status is therefore a necessary correlate of functional assessment. ADLs, which are necessary for self-care, are themselves divided into three levels from basic to advanced. At each level, the purposes of the functional assessment and the implications of changes in function are different. Normally, these activities are performed independently. As the frail elderly become progressively unable to do these tasks, they require more and more caregiving assistance.