Abstract
Background and Objectives: The identification of functional performance deficits is critical to the community independence of older adults. We examined whether a combined cognitive and performance-based medication management measure would be able to better classify an individual’s functional cognitive status and potential for instrumental activities of daily living (IADL) impairment than either measure alone.Research Design and Methods: Community-dwelling adults age 55 and older (n = 185) were administered the Mini-Cog, the Medication Transfer Screen-Revised (MTS-R), a combination measure the Medi-Cog-Revised (Medi-Cog-R), the Performance Assessment of Self-Care Skills (PASS) Checkbook Balancing and Shopping tasks (PCST), additional cognitive screening measures, and a self-report daily living scale. Receiver operating characteristic (ROC) curve analyses were computed for the Mini-Cog, MTS-R and the Medi-Cog-R using the PCST performance as the criterion measure. The area under the curve (AUC), sensitivity, and specificity were computed for each measure.Results: The Medi-Cog-R most accurately identified individuals as impaired on the PCST. An AUC statistic of 0.82 for the Medi-Cog-R was greater than either the Mini-Cog (0.75) or the MTS-R (0.73). The Medi-Cog-R demonstrated a sensitivity of 0.71 and a specificity of 0.78 in classifying individuals with impaired IADL as measured by the PCST.Discussion and Implications: The Mini-Cog, the MTS-R, and the Medi-Cog-R all show discriminant validity, but the combined measure demonstrates greater sensitivity and specificity than either component measure alone in identifying IADL impairment. The Medi-Cog-R appears to be a useful screening measure for functional cognition and can be used to prompt further assessment and intervention to promote community independence.
Highlights
Functional cognition has been defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities, including instrumental activities of daily living (IADL; Giles et al, 2017)
We examined the utility of two brief screening measures, the Mini-Cog (Borson et al, 2003), and a performance-based revision of the Medication Transfer Screen (MTS; Anderson et al, 2008), the Medication Transfer Screen-Revised (MTS-R) separately, and examined their combination—the Medi-Cog-Revised (Medi-Cog-R)—to determine the most effective screening tool to identify individuals at risk for functional cognition impairment
We made minor alterations to increase the performance demands of the MTS converting it from a paper and pencil to a practical task (MTS-R) by using pill bottles, fake medications and a 4 × 7 section medication organizer into which the fake medications are to be distributed
Summary
Functional cognition has been defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities, including instrumental activities of daily living (IADL; Giles et al, 2017). In the simplified environments of the acute or post-acute care (PAC) settings, IADL performance is not typically directly observable (Giles et al, 2017), and other methods of determining the presence of deficits significant enough to impair IADL are needed (Schmitter-Edgecombe et al, 2011; Gold, 2012). Research Design and Methods: Community-dwelling adults age 55 and older (n = 185) were administered the Mini-Cog, the Medication Transfer Screen-Revised (MTS-R), a combination measure the Medi-Cog-Revised (Medi-Cog-R), the Performance Assessment of Self-Care Skills (PASS) Checkbook Balancing and Shopping tasks (PCST), additional cognitive screening measures, and a self-report daily living scale. The area under the curve (AUC), sensitivity, and specificity were computed for each measure
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