various authors
Active participation in life corresponds to the concept of successful, active and healthy aging. The functional assessment Its objective is the planning of needs and the evaluation of the progress or evolution of patients. To do this, changes in functional capacity must be measured or recorded, aspiring to achieve the highest level of ability to carry out activities of daily living. This all-important issue is shared by both disciplines: Physiotherapy and Occupational Therapy.
The high functional level includes both physical and cognitive components. Both capacities indicate what the person can do, but not what he actually does. Active and healthy aging goes beyond potential, it refers to activity and it must be measured. To achieve this task in a simple, direct and efficient way we have a tool, the mongil test in its three variants: Basic Activities of Daily Living (ABVD), Instrumental Activities of Daily Living (AIVD) and Advanced Activities of Daily Living (AAVD). This test presents peculiarities and characteristics that make it different and that suppose an added benefit such as the estimation of the risk of geriatric syndromes.
The Mongil test is based on the CM 98 test of ABVD and the CM 98 test of AIVD1, which were studied in depth with the reference criteria of the original publication1,2.
Both tests (CM98 and Mongil) are characterized by have the same scoring system for each activity: 0, if the person does not present dependency; 1, intermediate grade, if you need help; and 2 if he is dependent or incapable. It is the system chosen in recent tests with the SARC-F (Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls), for sarcopenia3 or the FRAIL-NH4, for frailty.
He Mongil ABVD test It is presented in three blocks.
The first contains 3 activities related to the immobility syndrome5 and with the sarcopenia.3
1. Walk or ride. It is determined by observation.
2. Transfers. Get up and lie down on the chair or bed. It is determined by observation or questioning the patient and/or caregiver.
3. Go up and down stairs. Depending on how the first two are valued, this activity is sometimes presupposed.
The second block contains 3 bathroom related activities:
4. Go to the toilet or bathroom. He comes walking. The intermediate grade is when you need help to balance, put on or take off your clothes, or clean yourself. If the result is 1 or 2, it is related to the risk of falls.
5. Toilet
6. Bathroom
The third block contains 4 activities, which are those contemplated in the Blessed dementia test6.
7. Eat
8. Dress up
9. Urinary incontinence
10. Fecal incontinence
If we apply this test, we get closer to knowing the risk of presenting geriatric syndromes. “giants of Geriatrics”: immobility5, sarcopenia3, falls, urinary incontinence, dementia7 and, of course, frailty.4
The Mongil AIVD testhas two blocks (Figure 1):
The first is made up of the 4 activities (numbers 1 to 4) that predict the development of dementia8 in a year and number 5 (“Making purchases”) is an activity that is directly related to number 4 (“Managing money and bank accounts”).
- Use and management of the telephone
- Transportation
- Medication
- Money management and bank accounts.
- make purchases
The second block are three activities that take place at home:
- housework
- Laundry
- Cook
The Mongil AADL test9, contemplates 16 multidimensional activities, which provide interventions aimed at identifying effective strategies to increase active and healthy aging. It includes leisure, physical activity and gardening, participation in educational activities and others linked to the social environment, thus optimizing health opportunities (Figure 1). With the assessment of the activities in which the person participates, we can approach “Person-Centered Care” and identify the actions that have meaning in order to improve the quality of life.
It maintains the same scoring system as the previous tests, although this time, it is asked if you perform the activities habitually, which implies absence of dependency and it is scored as 0, if you do them occasionally, it is scored as 1 or intermediate degree and 2, when you never do.
The activities are:
- Reading
- Writing
- Watch tv
- Listen to the radio
- Cognitive stimulation activities (word searches, proverbs, riddles, sudokus, puzzles, among others).
- Crafts
- Physical activity, gymnastics
- religious activities
- Board games (cards, dominoes, bingo…)
- musical activities
- IT (computer use, tablet…)
- walk outside
- Gardening (pots, plants…)
- Maintains social relationships (family, friends…)
- Go to the movies, theater, parties
- Make excursions, trips
In some activities, information is added to complete the knowledge of the functional status of the elderly and at the end of the test, some questions are added about the assessment of the sense organs: sight and hearing, relevant in the development of functional assessment (Figure 1).
One of the key factors for active aging is the autonomywhich is perceived as the ability to control, adapt and be able to make personal decisions about one’s life and according to individual preferences.
Healthy aging is a process that lasts a lifetime, a process of optimizing opportunities to improve and preserve physical, social, and mental well-being, health, independence, and quality of life, and this is related to the activities of the daily life that provide successful interactions.
The Mongil test is a tool that can be used by both Physiotherapists, Occupational Therapists, Dietitians-Nutritionists, Nurses and Doctors. Which facilitates communication between everyone. The interpretation of the results of each one of the parts of the test is another favorable data, since, in all the tests, high scores always mean dependence, and the objective that must be pursued is to decrease that score, which would indicate a decrease in the dependence.
Being able to easily measure or record the previous functionality with the Mongil test and have knowledge of the starting or basal situation is essential in the assessment of the elderlyas well as being able to know precisely the changes in function, always seeking to achieve the highest possible level of functional capacity, which directly results in a better quality of care.
It is important to know that the function has a direct link with active aging. A person who feels useful, who perceives that they have not lost faculties, does not feel old. Thus, when a person stops doing activities that he used to do, usually the first ones to be lost are the AADLs, then the AIVDs and finally the ABDLs, it is when he really feels “old”10.
Therefore, the repercussion of functional loss in aging is of enormous importance, especially taking into account the progressive and almost unstoppable growth of the elderly population.
The Mongil test, in its three variants, shows tools that are short in their execution time and that, in addition, present practical applicability criteria In order to establish the greatest possible efficacy and efficiency in daily practice, it can be used at the different levels of care for the elderly (community, residence, hospital) either directly with them or through a reliable informant11.
Applying the three ADL scales, that is, the Mongil Activities of Daily Living test, both basic, instrumental and advanced (Figure 1)7,11 reinforces the commitment to improve the elderly and achieve that much appreciated successful, active and healthy ageing12.
BIBLIOGRAPHY
- López Mongil R. Geriatric Assessment in Nursing Homes. Publications Service. Valladolid: Center for Studies and Documentation of the Provincial Council of Valladolid; 2000.
- López Mongil R. Test CM 98 of Basic and Instrumental Activities of Daily Living. In: Clinical Measurement of Dementia. A resource guide. Bilbao: Editorial Fund Institute for Psychiatric Research; 2001. p. 359-68.
- Parra-Rodríguez L, Szlejf C, García-González AI, Malmstrom T, Cruz-Arenas E, Rosas-Carrasco O. Cross-Cultural Adaptation and Validation of the Spanish-Language Version of the SARC-F to Assess Sarcopenia in Mexican Community- Dwelling Older Adults. JAMDA 17. 2016: 1142-1146
- Chong E, Huang Y, Chan M, Nuo Tan H, Shiong Lim W. Concurrent and Predictive Validity of FRAIL-NH in Hospitalized Older Persons: An Exploratory Study. JAMDA 22. 2021: 1664-1669
- Martin Graczyk AI. Immobility Syndrome. Geriatrics in Primary Care. 3rd ed. Madrid: Medical Classroom; 2002. p. 273-83.
- Blessed G, Tomlinson B, Roth M. The association between quantitative measures of dementia and of senile change in cerebral gray matter of elderly subjects. Br J Psychiatry 1968; 114:797-811.
- López Mongil R, Gordaliza Ramos A, Pastor Cuadrado B, Carranza Priante MJ, Alonso Rodríguez L. Functional assessment: essential in the diagnosis, follow-up and intervention in dementias. Mongil Test of basic, instrumental and advanced activities of daily living. Congress of the General Foundation of the University of Salamanca. Salamanca; 2013.
- Barberger-Gateau P, Dartigues JF, Letenneur L. Four instrumental activities of daily living score as a predictor of one year incident dementia. Age Aging. 1993; 22:457-63.
- López Mongil R, Gordaliza Ramos A, Cano Calderón R, Alonso Bravo JA, Iglesias Ranilla S, Pastor Cuadrado B. Value of measuring advanced activities of daily living and its relationship with cognitive function. Rev Esp Geriatric Gerontol. 2013;48:9.
- Antón Jiménez M. Functional assessment. In: Gil Gregorio P, editor. Treatise on Neuropsychogeriatrics. Madrid: Spanish Society of Geriatrics and Gerontology; 2010: 105-27
- López Mongil R, Cognitive impairment/dementia: assessment and follow-up. Functional aspects. Rev Esp Geriatric Gerontol. 2017;52(Suppl 1):28-33.
- González González, XM (2016) Pedagogy of Longevity: Projecting a successful aging. Doctoral Thesis directed by Rocío Anguita and Inés Ruiz. Valladolid: University of Valladolid.
About the authors
Rosa Lopez Mongil
Geriatrician. Dr. Villacian Assistance Center
Valladolid Provincial Council
Mirella del Apio Tejedor
Physiotherapist. Cardinal Marcelo Residence
Valladolid Provincial Council
Xoan Gonzalez Gonzalez
Occupational therapist. Cardinal Marcelo Residence
Valladolid Provincial Council
Rafael Jesus Garcia Luque
Physiotherapist-Occupational Therapist. Dr. Villacian Assistance Center
Valladolid Provincial Council
Nerea of the Red Cross
Occupational therapist. Dr. Villacián Assistance Center and Cardenal Marcelo Residence
Valladolid Provincial Council
Angela Hernandez Ruiz
Dietitian-nutritionist. Ibero-American Nutrition Foundation (FINUT)
Grenade
Jose Antonio Lopez Wheat
Geriatrician. Accessibility Department
Malaga’s town hall