Palliative Performance Scale (PPS)
%: 100
Ambulation: Full
Activity/Evidence of Disease: Normal/no evidence
Self-Care: Full
Intake: Normal
LOC: Intact
%: 90
Ambulation: Full
Activity/Evidence of Disease: Normal/some
Self-Care: Full
Intake: Normal
LOC: Intact
%: 80
Ambulation: Full
Activity/Evidence of Disease: Normal with effort/some
Self-Care: Full
Intake: Normal or reduced
LOC: Intact
%: 70
Ambulation: Reduced
Activity/Evidence of Disease: Unable to do normal/some
Self-Care: Full
Intake: Normal or reduced
LOC: Intact or confusion
%: 60
Ambulation: Reduced
Activity/Evidence of Disease: Unable to do hobby or some housework/significant
Self-Care: Occasional assist
Intake: Normal or reduced
66
%: 50
Ambulation: Mainly sit/lie
Activity/Evidence of Disease: Unable to do any work/extensive
Self-Care: Considerable assist
Intake: Normal or reduced
LOC: Intact or confusion
%: 40
Ambulation: Mainly in bed
Activity/Evidence of Disease: Unable to do any work/extensive
Self-Care: Mainly assist
Intake: Normal or reduced
LOC: Intact, drowsy, or confusion
%: 30
Ambulation: Bed bound
Activity/Evidence of Disease: Unable to do any work/extensive
Self-Care: Total care
Intake: Reduced
LOC: Intact, drowsy, or confusion
%: 20
Ambulation: Bed bound
Activity/Evidence of Disease: Unable to do any work/extensive
Self-Care: Total care
Intake: Sips
LOC: Intact, drowsy, or confusion
%: 10
Ambulation: Bed bound
Activity/Evidence of Disease: Unable to do any work/extensive
Self-Care: Total care
Intake: Mouth care
LOC: Drowsy or coma
Instructions for PPS
Begin at the left column and read downward until the appropriate ambulation level is reached, then read across to the next column and downwards again until the activity/evidence of disease is located. These steps are repeated until all five columns are covered before assigning the PPS. Leftward columns (ambulation on left>activity level/evidence of disease>self-care>intake>LOC on right) are “stronger” determinants and take precedence over others to the right. PPS scores are in 10% increments. Choosing a “half-fit” level (such as 45%) is not correct. The combination of clinical judgment and “leftward” precedence determines the score. PPS may be used for: communication regarding functional status, criterion for workload assessment or other measurements/comparisons, and as a prognostic indicator.
Edmonton Frail Scale
67
Domain Item Score
Cognition Please imagine that this pre-drawn circle is a clock. 0 – no errors
Please place the numbers in the correct positions and 1- minor spacing errors Then place the hands to indicate a time of 2- other errors
“ten past eleven”
General In the past year how many times have you been 0-0, 1-1, 2- 2 or more
Health admitted to the hospital? Status
In general, how would you describe your health? 0-excellent, very good , or good 1-fair, 2-poor
Functional With how many of the following activities do you 0-1, 1-2 to 4, 2-5 to 8
Independence help: meal preparation, shopping, transportation, telephone, housekeeping, laundry, managing money, taking medications?
Social Support When you need help, can you count on someone who 0-always, 1-sometimes, 2-never is willing and able to meet your needs?
Medication Use Do you use five or more prescriptions on a regular basis? 0-no, 1-yes
At times do you forget to take your prescription medications? 0-no, 1-yes Nutrition Have you recently lost weight so that your clothing has 0-no, 1-yes
become looser?
Mood Do you often feel sad or depressed? 0-no, 1-yes
Continence Do you have a problem with losing control of urine when 0-no, 1-yes
You don’t want to?
Functional Please sit in this chair with your back and arms resting. 0-10 seconds or less
When I say “go”, please stand up and walk to the mark on 1-11 to 20 seconds
the floor (approximately 10 feet away), then turn around, 2->20 seconds or
return to the chair and sit down. unwilling, unable
Scoring: 0-5 not frail 6-7 vulnerable 8-9 mild frailty 10-11 moderate frailty 12-17 severe frailty
PCN Malnutrition Categories
68
Severe:Albumin < 2.0 g/dl
Prealbumin < 5.0 mg/dl
Ideal body weight <70%
Usual body weight <75% or *
BMI <16
Moderate:
Albumin < 2.5 g/dl
Prealbumin < 10.0 mg/dl
Ideal body weight <80%
Usual body weight <85%
BMI <17
Mild:
Albumin < 3.0 g/dl
Prealbumin < 15.0 mg/dl
Ideal body weight <90%
Usual body weight <95%
BMI <18.5
*unintended weight loss of > 5% in one month, >7.5% in 3 months, >10% in 6 months, or >20% in one year
“chronic” malnutrition is defined as a duration of three months or more.
At least two indicators should be present in addition to physical findings and high-risk clinical circumstances. Albumin and prealbumin should be considered one indicator, not two.
PCN Cerebral Performance Categories (CPC Scale)
69
CPC 1: good cerebral performance – conscious, alert, able to work, might have mild neurologic or psychologic deficitCPC 2: moderate cerebral disability – conscious, sufficient cerebral function for independent activities of daily life, able to work in sheltered environment
CPC 3: severe cerebral disability – conscious, dependent on others for daily support because of impaired brain function, ranges from ambulatory state to severe dementia or paralysis
CPC 4: coma or vegetative state – any degree of coma without the presence of all brain death criteria; unawareness, even if appears awake (vegetative state) without interaction with environment, may have spontaneous eye opening and sleep/awake cycles, cerebral unresponsiveness
PCN Function Assessment Barthel Index
70
ActivityFeeding:
0 = unable
5 = needs help cutting, spreading butter etc, or requires modified diet 10 = independent
Bathing:
0 = dependent
5 = independent (or in shower) Grooming:
0 = needs help with personal care 5 = independent face/hair/teeth/shaving Dressing:
0 = dependent
5 = needs help but can do about half unaided 10 = independent (including buttons, zips, laces) Bowels:
0 = incontinent (or needs to be given enemas) 5 = occasional accident
10 = continent Bladder:
0 = incontinent, or catheterized and unable to manage alone 5 = occasional accident
10 = continent Toilet Use:
0 = dependent 5 = needs some help
10 = independent (on and off, dressing, wiping) Transfers: (bed to chair and back)
0 = unable, no sitting balance
5 = major help (one or two people, physical) can sit 10 = minor help (verbal or physical)
15 = independent
Mobility: (on level surfaces) 0 = immobile or less than 50 yards
5 = wheelchair independent, including corners, more than 50 yards 10 = walks with help of one person (verbal or physical) more than 50 yards 15 = independent
Stairs:
0 = unable
5 = needs help (verbal, physical, carrying aid) 10 = independent
0 – 100 points