Iowa Geriatric Education Center Iowa Geriatric Education Center

Standardized Patient Actor Training

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Section 3 - The Alzheimer's Disease Patient

THE FUNCTIONAL ASSESSMENT

As your medical student doctor conducts the functional assessment, you should respond in a manner that is consistant with the description and documents on the previous page, and with the instructions to follow. If the student doctor leaves out a component of the functional assessment, do not immediately correct him or her. Rather, wait until he or she is finished, then point out what was missed and allow him or her the opportunity to perform the missed component of the assessment.

Questions About Function

The student doctor will probably open the conversation with a question about how you are functioning. If so, respond that everything is fine. As a patient with a dementing illness, you have no insight into the deficits identified by your spouse.

The learner should next ask specific questions about function, focusing on the levels of activities of daily living that were discussed in Section 2. As you may recall, basic activities of daily living are dressing, bathing, toileting, and other similar tasks. Because you appear well groomed and dressed, this would be an inappropriate place to start. It could be found offensive, and would also be an inefficient use of clinic time. Rather, the student doctor should begin by asking about the instrumental activities of daily living, following a checklist like the one provided to you on the previous page. If you have trouble doing a particular activity, the doctor should ask who, if anyone, does it for you.

When asked about instrumental activities of daily living, many patients with Alzheimer's disease say everything is fine, and the spouse will often contradict and provide the more correct assessment. However, in this simulated encounter, you will admit to your problems when asked. You have difficulty with cooking, cleaning, and managing money, all of which are handled by your spouse. You are able to do all other instrumental activities of daily living independently.

If the student asks about performing employment duties, you say something like "I'm retired, so that doesn't apply to me." If he or she asks about home maintenance, you reply to the effect that "I don't worry about that anymore."

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