The Australian 75+ Health Assessment: could it detect early functional decline better?

Abstract

Objective The aim of the present study was to identify opportunities to improve the reach and impact of the Australian Medicare 75+ Health Assessment (75+HA) to detect early functional decline (FD). Methods A comparison of two published review articles produced two outputs: (1) assessments identified in the systematic review that underpinned the 75+HA items were ranked for evidence of effectiveness and compared with the volume of research into assessment areas identified by a recent review on indicators of early FD; and (2) items in the 75+HA were compared with those in the recent review. Results The review underpinning the 75+HA found 19 assessment areas, with strongest evidence of effectiveness for vision/hearing, teeth/oral, balance/gait, cognitive and service use. The more recent review reported on six domains (eight subdomains) of FD assessment: physical and cognitive elements of the performance capacity domain were the least well assessed, whereas the most comprehensively assessed domains were health service use, performance capacity (mental subdomain), participation (motivation/volition subdomain) and demographics. The 75+HA addresses only some items related to early FD as identified by the recent literature. Conclusion Reassessment of the 75+HA with a view to including current evidence-based assessments for early FD is recommended. Updating the 75+HA items with ways to detect FD earlier may increase its relevance to Australia’s ageing population. What is known about the topic? There are consistent predictions of increasing lifespan of Australians, increasing numbers of older Australians wanting to live independently in the community and the increasing burden on already scarce hospital resources associated with managing the ramifications of declining function in older Australians. The 75+HA is now 15 years old and has not been updated. The imperative is to identify and address early FD in primary care before it becomes a problem. What does this paper add? This paper highlights how the 75+HA can be updated to support a comprehensive and multifactorial assessment of early FD, making it more relevant to the current climate of aging Australians and their desire to age in place. Adding the elements suggested in this paper to the 75+HA may assist in increasing the relevance of the assessment and in the earlier detection of FD. What are the implications for practitioners? A regular comprehensive assessment of key antecedents and features of early FD from multiple stakeholder perspectives will provide a stronger and more evidence-based framework within which to support older Australians to age in place.