Diagnosing dementia in long-term care facilities.

Abstract

SUMMARY Detection and accurate diagnosis of cognitive impairmentand dementia in LTCF remains deficient. Failure to recognizedementia can lead to failure to protect the patient from theirown poor decision-making, and produce misunderstandingsbetween residents and caregivers who are not aware of howdementia is influencing the resident’s behavior. Failure toassess and document dementia and related problems can de-crease reimbursement under the skilled nursing facility pro-spective payment system and lead to survey citations. Failureto accurately diagnosis dementia in LTCFs deprives the resi-dent the advantages of early treatment and can increase therisk of medication errors, falls, delirium, and other dementia-related problems. Failure to prepare staff to provide necessaryphysical and emotional care will lead to unnecessary sufferingof LTCF residents with dementia, from entry into the facilityto end-of-life. REFERENCES 1. Roe C, Anderson M, Spivack B. Use of anticholinergic medications byolder adults with dementia. J Am Geriatr Soc 2002;50:836 –842.2. Jantti P, Pyykko V, Hervonen A. Falls among elderly nursing homeresidents. Am J Public Health 1993;107:89–96.3. Jensen J, Nyberg L, Gustafson Y, Lundin-Olsson L. Fall and injuryprevention in residential care—Effects in residents with higher and lowerlevels of cognition. J Am Geriatr Soc 2003;51:627–635.4. McNicoll L, Pisani MA, Zhang Y, et al. Delirium in the intensive careunit: Occurrence and clinical course in older patients. J Am Geriatr Soc2003;51:591–598.5. Rahkonen T, Luukkainen-Markkula R, Paanila S, et al. Delirium episodeas a sign of undetected dementia among community dwelling elderlysubjects: A two-year follow-up study. J Neurol Neurosurg Psychiatry2000;69:519–521.6. McCusker J, Cole M, Dendukuri N, et al. Delirium in older medicalinpatients and subsequent cognitive and functional status: A prospectivestudy. Can Med Assoc J 2001;165:575–583.7. Fick D, Foreman M. Consequences of not recognizing delirium superim-posed on dementia in hospitalized elderly individuals. J Gerontol Nurs2000;26:30–40.8. Fick D, Agostini J, Inouye S. Delirium superimposed on dementia: Asystematic review. J Am Geriatr Soc 2002;50:1723–1732.9. Cohen-Mansfield J, Creedon M. Nursing staff members’ perceptions ofpain indicators in persons with severe dementia. Clin J Pain 2002;18:64–73.