title: National survey of family physicians to define functional decline in elderly patients with minor trauma.
abstract: Failing to assess elderly patients for functional decline at the time around a minor injury may result in adverse health outcomes. This study was conducted to define what constitutes clinically significant functional decline and the sensitivity required for a clinical decision instrument to identify such functional decline after an injury in previously independent elderly patients.
  
  
  
  After a thorough development process, a survey questionnaire was administered to a random sample of 178 family physicians. The surveys were distributed using a modified Dillman technique.
  
  
  
  From 143 eligible surveys, we received 67 completed surveys (response rate, 46.9 %). Respondents indicated that a drop of at least 3 points on the 28-point Older Americans Resources and Services (OARS) ADL Scale was considered clinically significant by 90 % of physicians. Ninety percent (90 %) of physicians would be satisfied with a sensitivity of 90 % or more for a clinical decision instrument to detect patients at risk of functional decline at 6 months following an injury. The majority of family physicians do not routinely assess the majority of the tasks on the OARS scale for injured elderly patients.
  
  
  
  A high proportion of physicians (90 %) would consider a drop of 3 points on the OARS ADL Scale as significant to define functional decline and would be satisfied with a sensitivity of 90 % for a clinical decision instrument to detect such a decline. Any instrument to identify patients at elevated risk for subsequent decline should consider these outcome measures to be clinically useful.
authors.affiliation: Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada.|Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Kasim E
authors.initials: KE
authors.lastname: Abdulaziz
authors.affiliation: Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada.|Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Jamie
authors.initials: J
authors.lastname: Brehaut
authors.affiliation: Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada.|Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Department of Family and Emergency Medicine, Université Laval, Laval, QC, Canada.|Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec, Laval, QC, Canada.
authors.forename: Marcel
authors.initials: M
authors.lastname: Émond
authors.affiliation: Département de réadaptation, Université Laval, Laval, QC, Canada.|Unité de recherche en traumatologie-urgence-soins intensifs du Centre de recherche FRQ-S du CHA de Québec, Laval, QC, Canada.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Sirois
authors.affiliation: Department of Emergency Medicine, University of Toronto, Clinical Epidemiology Unit, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
authors.forename: Jacques S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Wilding
authors.affiliation: Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada. jperry@ohri.ca.|Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada. jperry@ohri.ca.|Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. jperry@ohri.ca.|Epidemiology Program, F6, The Ottawa Hospital, Civic Campus 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada. jperry@ohri.ca.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005194:Family Practice; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000503:physiopathology*
keywords: Activities of daily living (ADL); Elderly; Emergency department; Functional decline; Minor injuries