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FUNCTIONAL ASSESSMENT SCREENING TOOL (FAST)

ASPECTS OF FUNCTIONING Ref: "Best Practice Approaches to Minimise Functional Decline in Older People..." PHYSICAL HEALTH Dx:-----------------------------------------------------Have you been in hospital in the past 6 mths? PAIN: Acute Chronic PROBLEMS IDENTIFIED ON ADMISSION PRE-MORBID Level of FUNCTIONING

DRUG & ALCOHOL: Type, Amount, Frequency Alcohol---------------------------------------------------Cigarettes-----------------------------------------------OTC Drugs---------------------------------------------Prescription drugs------------------------------------Illicit drugs-----------------------------------------------COGNITION & EMOTIONAL HEALTH Cognitive Impairment, ABI, CVA, ID, Head Trauma, Brain neoplasm, Dx:_________________ PHx of mental illness Dementia Year Dx:_____________________ Short-term memory problems Trouble recalling words or names of things Delirium: Ref: Delirium Management CPGs. P/Hx of episodes of acute confusion Cognitive impairment, dementia Currently acutely confused Onset? -------------Disoriented to Time / Person and/or Place Fluctuating LOC-lucid-alert-drowsy-agitated Depression P/Hx of depressive episodes Currently depressed How long?------------------Sleep Appetite Disturbance of Mood Enjoyment of usual activities Anxiety / Panic Do you worry too much / all the time? Do you have a problem with your nerves? Do your nerves ever stop you doing things? Have you ever suffered feelings of panic? Care issues Concerns about `at risk' behaviour & safety Unkempt self care deficit Carer stress MOBILITY, SELF CARE & VIGOUR Mobility History of wandering Dependent Independent with aid -------------------------------Requires assistance ­ describe-------------------TRANSFERS: (bed, chair, toilet, shower) Dependent/assist ­ Describe ____________ Independent with aid (describe)____________ Falls Falls in past 12 months.No___Most recent___ Balance / Gait problems - Describe Sensory deficits ------------------------------------Self Care: (Showering/grooming/dressing) Supervision/prompting/aids required Requires physical assistance Dependent CONTINENCE Incontinent of urine ­ stress/urge incontinence Double incontinence History of constipation Recent indwelling catheter NUTRITION & HYDRATION Loss or / Decrease in appetite Recent weight loss. How much?------------------Dehydration Swallowing difficulties ­ Chokes when eating SKIN INTEGRITY Skin tears, wounds / Pressure ulcers Incontinent Impaired mobility/ immobile MEDICATION Recent changes to medication regime 6 or more medications Medication not taken as prescribed

Positive answer to any of the items above = Positive Screen

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FUNCTIONAL ASSESSMENT SCREENING TOOL (FAST)

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