Functional assessment in geriatric mental health

Knowledge of functional status in older adulthood is critical to informing diagnosis of neurocognitive and mental disorders that commonly affect older adults, facilitating decisions about need for transition to higher levels of care, and demonstrating effectiveness of treatments in clinical trials or daily practice. Despite broad clinical and public health implications, the knowledge base about daily function in normative aging, neurodegenerative diseases, and mental disorders in older adulthood has gaps and inconsistencies across these aging populations. In this chapter, we first provide an overview of current functional assessment methodologies used with older adult populations and describe a conceptual framework for cognitively mediated daily function. We outline current obstacles associated with measuring and monitoring daily function in older adults with conventional assessment paradigms. Next, we provide a brief review of the literature on assessment of daily function in normative aging, mild cognitive impairment, and Alzheimer’s disease. We highlight recent applications of remote sensing and pervasive computing technologies to improve objective characterization of function and subtle changes or decline in functioning, which are clinically meaningful in older adults but are not well captured by currently available assessment tools. Finally, we provide a brief review of functional assessment research in older adult mental disorders, with a specific focus on older adult depression, schizophrenia, and bipolar disorders. We conclude by summarizing key findings across aging populations and discussing directions for future research.