To integrate or segregate the cognitively impaired and cognitively intact in nursing homes: Lessons to be learned from educational mainstreaming

Introduction The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. Objective To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Methods Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge - FIM admission). Absolute functional gain was analyzed in respect to cognitive status. Results Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p<0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p<0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p<0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p>0.05). Conclusion The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favorable short term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

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Nursing Home Food Services Linked with Risk of Malnutrition

Canadian Journal of Dietetic Practice and Research ◽

10.3148/68.1.2007.14 ◽

2007 ◽

Vol 68 (1) ◽

pp. 14-20 ◽

Cited By ~ 31

Author(s):

Natalie Carrier ◽

Denise Ouellet ◽

Gale E. West

Keyword(s):

Nursing Homes ◽

Food Service ◽

Food Delivery ◽

Food Services ◽

Face To Face ◽

Service Characteristics ◽

Food Packages ◽

Final Sample ◽

Cognitively Intact ◽

Service Factors

Purpose: Links between food service characteristics and residents’ risk of malnutrition were examined. Methods: Cognitively intact residents meeting inclusion criteria and living in one of 38 participating nursing homes were randomly sampled. The final sample consisted of 132 residents, who were screened for risk of malnutrition and completed a face-to-face interview questionnaire about dining experiences. Additional data came from participants’ medical charts, and each institution's food service manager completed a written questionnaire. Frequencies and logistic regressions were used to describe the sample and to examine relationships between risk of malnutrition and food service characteristics. Results: Overall, 37.4% of participants were at risk of malnutrition. Food service factors, including food packages, lids, and dishes that were difficult to manipulate (β=0.285, p=0.009), bulk food-delivery systems (β=1.329, p=0.036), overall food satisfaction (β=0.253, p=0.044), menu cycle length (β=-2.162, p=0.003), and porcelain dishes (β=-0.345, p=0.052), all were significantly associated with risk of malnutrition. Conclusions: Our findings clearly show a need for nursing homes to modify certain aspects of food service that may increase the risk of malnutrition among cognitively intact residents.

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A path analysis on the direct and indirect effects of the unit environment on eating dependence among cognitively impaired nursing home residents

BMC Health Services Research ◽

10.1186/s12913-019-4667-z ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Alvisa Palese ◽

Luca Grassetti ◽

Valentina Bressan ◽

Alessandro Decaro ◽

Tea Kasa ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Nursing Care ◽

Indirect Effects ◽

Functional Dependence ◽

Cognitively Impaired ◽

Direct And Indirect Effects ◽

Care Level ◽

Individual Level ◽

The Individual

Abstract Background This study aims to estimate the direct and indirect effects of the unit environment alongside individual and nursing care variables on eating dependence among residents who are cognitively impaired and living in a nursing home. Method A multicentre observational study was carried out in 2017: 13 Italian nursing homes were involved in data collection. Included residents were aged > 65 at baseline, living in the considered facility for the last 6 months and during the entire study period and having received at least one comprehensive assessment. Data were collected (a) at the individual level: eating dependence using the Edinburgh Feeding Evaluation in Dementia Scale and other clinical variables; (b) at the nursing care level with daily interventions to maintain eating independence assessed with a checklist; and (c) at the nursing home level, using the Therapeutic Environment Screening Survey for Nursing Homes. Results One thousand twenty-seven residents were included with an average age of 85.32 years old (95% CI: 84.74–85.89), mainly female (781; 76%). The path analysis explained the 57.7% variance in eating dependence. Factors preventing eating dependence were: (a) at the individual level, increased functional dependence measured with the Barthel Index (β − 2.374); eating in the dining room surrounded by residents (β − 1.802) as compared to eating alone in bed; and having a close relationship with family relatives (β − 0.854), (b) at the nursing care level, the increased number of interventions aimed at promoting independence (β − 0.524); and (c) at the NH level, high scores in ‘Space setting’ (β − 4.446), ‘Safety’ (β − 3.053), ‘Lighting’ (β − 2.848) and ‘Outdoor access’ (β − 1.225). However, environmental factors at the unit level were found to have also indirect effects by influencing the degree of functional dependence, the occurrence of night restlessness and the number of daily interventions performed by the nursing staff. Conclusion Eating dependence is a complex phenomenon requiring interventions targeting individual, nursing care, and environmental levels. The NH environment had the largest direct and indirect effect on residents’ eating dependence, thus suggesting that at this level appropriate interventions should be designed and implemented.

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Treatment of Pain in Cognitively Impaired Compared with Cognitively Intact Older Patients with Hip-Fracture

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1998.tb06644.x ◽

1998 ◽

Vol 46 (9) ◽

pp. 1079-1085 ◽

Cited By ~ 233

Author(s):

Karen S. Feldt ◽

Muriel B. Ryden ◽

Steven Miles

Keyword(s):

Hip Fracture ◽

Older Patients ◽

Cognitively Impaired ◽

Cognitively Intact

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Disagreement in preference for residential care between family caregivers and elders is greater among cognitively impaired elders group than cognitively intact elders group

International Journal of Geriatric Psychiatry ◽

10.1002/gps.2296 ◽

2009 ◽

pp. n/a-n/a ◽

Cited By ~ 3

Author(s):

Pui Hing Chau ◽

Timothy Kwok ◽

Jean Woo ◽

Felix Chan ◽

Elsie Hui ◽

...

Keyword(s):

Family Caregivers ◽

Residential Care ◽

Cognitively Impaired ◽

Cognitively Intact

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Assessing Capacity in the Elderly: Comparing the MoCA with a Novel Computerized Battery of Executive Function

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000478008 ◽

2017 ◽

Vol 7 (2) ◽

pp. 249-256 ◽

Cited By ~ 6

Author(s):

Megan Brenkel ◽

Kenneth Shulman ◽

Elias Hazan ◽

Nathan Herrmann ◽

Adrian M. Owen

Keyword(s):

Older Adults ◽

Executive Function ◽

Cognitive Assessment ◽

Screening Tool ◽

The Elderly ◽

Cognitively Impaired ◽

Cognitive Screening ◽

Decision Making Capacity ◽

Brain Sciences ◽

Cognitively Intact

Background/Aims: Clinicians are increasingly being asked to provide their opinion on the decision-making capacity of older adults, while validated and widely available tools are lacking. We sought to identify an online cognitive screening tool for assessing mental capacity through the measurement of executive function. Methods: A mixed elderly sample of 45 individuals, aged 65 years and older, were screened with the Montreal Cognitive Assessment (MoCA) and the modified Cambridge Brain Sciences Battery. Results: Two computerized tests from the Cambridge Brain Sciences Battery were shown to provide information over and above that obtained with a standard cognitive screening tool, correctly sorting the majority of individuals with borderline MoCA scores. Conclusions: The brief computerized battery should be used in conjunction with standard tests such as the MoCA in order to differentiate cognitively intact from cognitively impaired older adults.

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Cognitive screening of older adults: the utility of pentagon drawing

International Psychogeriatrics ◽

10.1017/s1041610212001998 ◽

2012 ◽

Vol 25 (3) ◽

pp. 413-419 ◽

Cited By ~ 8

Author(s):

Edward Helmes

Keyword(s):

Older Adults ◽

Community Dwelling ◽

Cognitively Impaired ◽

Point System ◽

Cognitive Screening ◽

Verbal Tasks ◽

Bender Gestalt Test ◽

Cognitively Intact ◽

State Examination

ABSTRACTBackground: Drawing tests have a long history in neuropsychological assessment. A popular geometric figure has been the two intersecting pentagons from the Bender Gestalt test. Reproducing the pentagons is the main visuospatial task on the original Mini-Mental State Examination (MMSE), remaining in use in revised versions of that widely used screening test. Scoring criteria on the MMSE are binary: perfect reproduction of the figure is required, while the Modified MMSE of Teng and Chui (1987) uses a more refined ten-point scoring for the elements of the figure.Methods: Here, I report on the use of pentagon drawing from 8,702 older community-dwelling Canadians (59.3% female), with a mean age of 75.5 years (SD = 6.99) and 10.1 years of education (SD = 3.89). Mean scores for the whole sample are reported, as well as for subsamples who underwent a full clinical assessment and were diagnosed as cognitively intact, with dementia, or cognitively impaired, but without dementia. Logistic regression was used to evaluate the utility of pentagon drawing as a diagnostic tool to diagnose cognitive impairment.Results: Binary scoring was less effective in discriminating groups than the ten-point system and showed weaker properties by other criteria.Conclusions: The discussion focuses on the role of simple, non-verbal tasks in the cognitive screening of older adults.

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