Social Domain
Social Functioning
While social functioning may seem out of the realm of the physician, it is a crucial part of the overall functional picture. In the USA, the social network (spouses and children) provides much of the care for older patients; for example, informal caregiving by family makes up a large portion of overall costs for patients with dementia.[56] Assessment of the strength of the social network can provide valuable information about how long the patient will live independently, the needed mechanisms of support to remain independent, and the patient's ability to plan and adapt to environmental challenges. A short discussion can provide a basic understanding of the social network and support systems.
Social Support Assessment. The provider should identify whom the patient would call in an emergency and obtain the contact information. Support networks can be assessed by identifying who the patient believes would provide care for them if they were unable to care for themselves. These questions conveniently segue into a discussion about healthcare proxy decisions and end-of-life choices, which is crucial for physicians to assess for their patients, particulary during times of stable health when patients can take time to think about these important questions and discuss with family members. Ideally, patients should provide written documentation of their choices of healthcare proxy and advanced directives. The format of this documentation varies by location. For example, many states in the USA now support more comprehensive documentation, such as medical (or physician) orders for life-sustaining treatment, which serve as standardized orders honored by care providers across multiple settings.[103]
Home Safety Assessment, Older patients are at risk for environmental conditions in the home because of decreased mobility and cognition. The provider should assess for common home conditions that can be unsafe. Smoke and carbon monoxide detectors can provide advanced warning of life-threatening emergencies and are relatively inexpensive to purchase and operate. Tobacco use in the home can be a risk factor for fires and burns. Simple environmental changes (e.g., grab bars, shower seats and removal of throw rugs, among others) in the home can prevent falls and the resultant morbidity of falls. Additionally, older patients with cognitive impairment should not have access to firearms due to the risk of either accidental or intentional suicide.
Aging Health. 2013;9(6):579-591. © 2013 Future Medicine Ltd.
