Even in Geriatrics, Daily Living Needs Go Unchecked

Primary care clinicians are not routinely assessing older patients’ abilities to perform activities of daily living (ADLs), even in clinics specializing in geriatric care, according to research presented at the Gerontological Society of America (GSA) 2026 Annual Scientific Meeting in National Harbor, Maryland.But adopting standardized assessments into existing workflows can improve the identification of older adults at risk for unmet needs, said Tony Rosen, MD, MPH, associate professor of emergency medicine and geriatric injury prevention at Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York City, who helped lead a study on assessing for ADL dependence and resistance to care.“The challenge with these unmet care needs is that they can have serious medical consequences,” particularly for older adults with dementia, Rosen said. “What we heard [from primary care clinicians] was, ‘No, I don’t do this. But wow, it would really be helpful if we did.’”Rosen and colleagues conducted four focus groups with primary care clinicians and staff from general internal medicine and geriatrics clinics. They used semistructured interviews to explore current practices for assessing ADL dependence and caregiver capabilities, as well as barriers to assessment.An analysis identified five major themes related to assessment practices and documentation:ADL assessments are not routine across visits; however, they could be performed during new patient visits, Medicare annual wellness visits, or as functional concerns arise.Changes in function are clinically important. Primary care clinicians and staff emphasized the importance of identifying new or worsening ADL dependence, which may indicate increased caregiving needs.Current documentation of ADL issues is variable and often unstructured, frequently through free-text notes or social histories. This use limits the ability to track functional changes over time in the electronic health record (EHR).Caregiver capabilities and strain were generally assessed informally. Participants described interpersonal challenges when evaluating how well caregivers could meet patient needs.Workflow integration is feasible but must be practical. Assessments could be conducted via previsit questionnaires, registration-based screening, and during vital sign collection.Medicare recommends clinicians ask about ADLs during annual wellness visits but does not provide a template for gathering granular information that could be most informative, Rosen said.Rosen and colleagues also created an 18-item questionnaire to be filled out by a caregiver before a visit. Caregivers are asked about patients’ difficulties bathing and dressing, cognitive and functional challenges, safety risks, and their difficulties meeting care needs. They plan to pilot the tool at an outpatient geriatric primary care clinic.The assessment can help track changes. If a patient did not previously need help toileting, “and now they need an enormous degree of help toileting, that sounds like an important substantive change to explore with the caregiver to make sure that they’re able to provide care,” Rosen said.Three components comprise measuring ADL abilities: screening, documenting, and acting on the information, said Rebecca Brown, MD, MPH, associate professor of medicine at the University of Pennsylvania Perelman School of Medicine and geriatrician at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, who attended the conference.Each step presents challenges, she said, including time limitations and a lack of education about which resources to provide after assessment. Clinics might prompt patients and caregivers to answer questions before a visit via the EHR and build in referral menus to manage these issues.Brown and colleagues presented research at the meeting examining screening for the ability to perform ADLs at eight primary care sites affiliated with the VA. Nurses screened more than 10,000 patients, about 10% of whom screened positive for some ADL impairment. Nurse adoption of the pilot workflow was 100% compared with 46% among primary care clinicians. Just 42% of positive screens were assessed by primary care clinicians within 7 days.The findings suggest that the intervention improves identification of functional impairment in primary care, but additional strategies are needed to improve rates of follow-up assessment, Brown said.Rosen and Brown reported having no relevant financial disclosures.Karen Blum is a freelance medical and science writer in the Baltimore area.