Interview For Mental Status Research Articles

Cognitive assessment of nursing home residents: Survey data on tools used and perceptions of use among social service professionals in one U.S. state.

Background: Social service professionals routinely use screening tools to assess for cognitive decline or identify suspected dementia in nursing home residents. Published literature lacks details about the specific tools used and how professionals use and perceive them in practice. The aim of this study is to better understand cognitive screening roles performed by nursing home social service professionals and how they view their use and efficacy.Methods: An online survey was administered to all 230 nursing homes in the US state of Alabama between October 2021 and March 2022. Fifty-three social service professionals who conduct resident cognitive screenings responded to the survey.Results: In addition to completing the US-mandated Brief Interview of Mental Status (BIMS) quarterly, 75% of participants reported using additional tools, most notably the Mini Mental Status Examination (MMSE). Participants reported using different tools for varied purposes. Those who used both the BIMS and MMSE rated the BIMS significantly higher on ease and time to administer while rating the MMSE higher on reliability and validity. Although most participants reported high levels of confidence using the tools, over half of participants indicated interest in further training in cognitive assessment tools.Discussion: Findings provide evidence regarding who administers nursing home cognitive screenings, which tools are used, and their experiences using those tools. Participant responses reveal the value of using multiple screening tools for improved detection of cognitive status and decline for residents as well as a need for additional training in cognitive assessment. Findings also suggest that the primary tool used for cognitive screening may be quick and easy to use at the expense of perceived reliability and validity. Further evaluation of nursing home cognitive assessment is needed.

Post-acute sequelae of SARS-CoV-2 (PASC) in nursing home residents: A retrospective cohort study.

Post-acute sequelae of SARS-CoV-2 (PASC) describes a syndrome of physical and cognitive decline that persists after acute symptoms of infection resolve. Few studies have explored PASC among nursing home (NH) residents. A retrospective cohort study was conducted at two NHs in Michigan. COVID-positive patients were identified from March 21, 2020 to October 26, 2021. The comparison group were patients who lived at the same NH but who were never infected during the study period. Minimum Data Set was used to examine trajectories of functional dependence (Activity of Daily Living [ADL] composite score) and cognitive function (Brief Interview for Mental Status [BIMS]). Linear mixed-effects models were constructed to estimate short-term change in function and cognition immediately following diagnosis and over time for an additional 12 months, compared to pre-COVID and non-COVID trajectories and adjusting for sex, age, and dementia status. We identified 171 residents (90 COVID-19 positive, 81 non-COVID) with 719 observations for our analyses. Cohort characteristics included: 108 (63%) ≥ 80 yrs.; 121 (71%) female; 160 (94%) non-Hispanic white; median of 3 comorbidities (IQR 2-4), with no significant differences in characteristics between groups. COVID-19 infection affected the trajectory of ADL recovery for the first 9 months following infection, characterized by an immediate post-infection decrease in functional status post-infection (-0.60 points, p = 0.002) followed by improvement toward the expected functional trajectory sans infection (0.04 points per month following infection, p = 0.271). NH residents experienced a significant functional decline that persisted for 9 months following acute infection. Further research is needed to determine whether increased rehabilitation services after COVID-19 may help mitigate this decline.

Comparison of the Brief Interview for Mental Status (BIMS) and Montreal Cognitive Assessment (MoCA) for identifying cognitive impairments and predicting rehabilitation outcomes in an inpatient rehabilitation facility.

The Brief Interview for Mental Status (BIMS) is the Centers for Medicare and Medicaid Services' primary cognitive assessment for multiple health care settings. However, research suggests that the BIMS has low sensitivity in detecting mild cognitive impairment in community samples and nursing home residents. To determine the sensitivity of the BIMS in identifying patients with mild or moderate cognitive impairments in an inpatient rehabilitation setting and the relationship of BIMS and Montreal Cognitive Assessment (MoCA) scores with rehabilitation outcomes. Retrospective cohort. Inpatient rehabilitation facility. A total of 2252 patients admitted for orthopedic or general rehabilitation. The sensitivity and specificity of the BIMS for identification of cognitive impairments were determined using validated cutoff scores on the MoCA as criterion. Multivariable ordinal regression was employed to determine if MoCA and BIMS scores were independent predictors of rehabilitation outcomes. Functional independence at discharge (GG scores), rehabilitation efficiency (GG change per day), length of stay (LOS), and discharge destination. The BIMS had low sensitivity in identifying moderate (0.384) or mild (0.257) cognitive impairment. Patients classified as having moderate cognitive impairment on the MoCA had lower GG scores at discharge (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.30 to 0.46) and rehabilitation efficiency (OR 0.43, CI 0.34 to 0.53) compared to individuals identified as impaired on the BIMS (GG scores: OR 0.63, CI 0.52 to 0.78; efficiency: OR 0.71, CI 0.58 to 0.86). LOS (OR 1.49, CI 1.19 to 1.85) and discharge destination (OR 0.47, CI 0.28 to 0.77) were uniquely predicted in patients identified as moderately impaired on the MoCA but not the BIMS (LOS: OR 0.99, CI 0.80 to 1.21; discharge home: OR 0.93, CI 0.62 to 1.38). The BIMS had low sensitivity for detection of mild and moderate cognitive impairments. Compared to the MoCA, the BIMS was less effective at predicting rehabilitation outcomes.

Examination of the Presence of COVID-19 Encephalopathy on Inpatient Acute Rehabilitation Outcomes and Disability

<h3>Research Objectives</h3> The objective of the current study was to investigate the impact of COVID-19 encephalopathy on acute inpatient rehabilitation outcome. <h3>Design</h3> This retrospective study assessed functional ability pre-intervention (admission) and post-intervention (discharge) among COVID-19 patients who received acute inpatient rehabilitation between April 2020 and March 2021. <h3>Setting</h3> Participants received care in a dedicated COVID unit at a freestanding acute inpatient rehabilitation facility. <h3>Participants</h3> 161 inpatients were divided into two groups according to COVID-encephalopathy status: 87 negative (CE-) and 74 positive (CE+). Encephalopathy status was determined based on Chart-Based Delirium Identification Instrument using electronic medical records. The sample was 61% male / 39% female, 62% White, 14% Black, 8% Hispanic, 4% Asian, 12% Other/declined. Mean age was 62 (SD=15.2) and mean education was 13 years (SD=3.9). <h3>Interventions</h3> Rehabilitation interventions utilized a medically-based, multidisciplinary approach. All participants received a minimum of three hours of physical, occupational and/or speech therapy five days / week during inpatient stay. <h3>Main Outcome Measures</h3> The total raw score from the self-care and mobility section of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) was used to assess overall functional ability at admission and discharge. The Brief Interview for Mental Status was utilized to assess orientation. <h3>Results</h3> At admission, encephalopathy groups did not differ in overall ability. In contrast, at discharge overall ability was significantly higher with encephalopathy and IRF-PAI change per day trended higher with encephalopathy. Finally, at discharge orientation was associated with overall ability in the CE+ group. <h3>Conclusions</h3> Following inpatient rehabilitation CE+ patients had less overall disability than CE- patients but residual problems with cognitive functioning were associated with severe overall disability in the CE+ group. Findings highlight the complexity of COVID-19 symptom manifestation and persistent physical and cognitive deficits during the course of a COVID-19 infection and recovery. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to declare nor any financial or non-financial interests to disclose.

A Cross Sectional Study on Assessment of Cognitive Impairment and Behavioural Risk Factors Among Senior Citizens Living in Old Age Homes in Chengalpattu District, Tamilnadu

Background: Ageing is an irreversible, unavoidable, universal phenomenon accompanied by gradual reduction in functional capacity of the elderly. The number of elderly populations in India is expected to triple reaching 2 billion. This study aims to estimate the prevalence of cognitive impairment and evaluate the association between various socio demographic and behavioural risk factors. Methodology: This descriptive cross-sectional study was carried among 330 senior citizens living in old age homes by using a two-stage multistage sampling method. A standardized pretested structured questionnaire containing Brief Interview for Mental Status (BIMS) scale was used. Data was analysed using SPSS (Version 22). Results: Among 330 study respondents, around 44% had mild -to- moderate cognitive impairment and 36% had severe cognitive impairment. Nearly 74.8% have their habit of regular physical activity. Among the study subjects approximately 4% of them were current smokers, 5.2% had the habit of regular alcohol consumption previously. Conclusion: Integration of NPHCE and NMHP can be beneficial in early diagnosis of mild cognitive impairment during weekly outpatient visits at PHC. Level of attention given towards Alzheimer’s disease is more when compared to screening for cognitive impairment which is an early precursor for Alzheimer’s Disease.

Functional and cognitive outcomes after suprapubic catheter placement in nursing home residents: A national cohort study.

Long-term functional and cognitive outcomes in nursing home residents after procedures are poorly understood. Our objective was to evaluate these outcomes after suprapubic tube (SPT) placement. We performed a retrospective, cohort study in the nursing home setting. Participants were long-term nursing home residents who underwent SPT placement from 2014 to 2016 in the United States. SPT placements were identified in Medicare Inpatient, Outpatient, and Carrier files using International Classification of Diseases and Current Procedural Terminology codes. Residents were identified through the Minimum Data Set (MDS) 3.0 for Nursing Home Residents. MDS Activities of Daily Living (MDS-ADL) and Brief Interview for Mental Status (BIMS) scores were used to assess function and cognition, respectively. Outcomes of interest were worsening MDS-ADL and BIMS scores at 1year postoperatively, 30-day postoperative complications, and 1-year mortality. Functional and cognitive trajectories were modeled to 1 year postoperatively using mixed-effect spline models. From 2014 to 2016, 9647 residents with a mean age of 80.9 (SD 8.1) years underwent SPT placement. At 1year postoperatively, 37.6% of residents died, while of survivors, 33.7% had worsening MDS-ADL and 36.2% worsened BIMS. Residents had steeper postoperative rates of functional decline compared to relatively stable preoperative trends that never recovered to baseline status. However, robustly characterizing an association between SPT placement and functional decline would require a propensity score matched cohort without SPT placement. Decline in cognitive status was not clearly associated with SPT placement, suggesting either the natural course of a vulnerable population or limitations of BIMS scores. Outcomes important to older adults, such as functional ability and cognitive status, do not show improvement after SPT placement. These findings emphasize that this "minor" procedure should be considered with caution in this population and primarily for palliation.

Examining the Clinical Utility of the Brief Interview for Mental Status.

The Brief Interview for Mental Status (BIMS) is used to identify delirium and needed supports in patients living in skilled nursing facilities (SNFs) and long-term care facilities (LTCFs). We analyzed 3,537,404 patients discharged from acute hospitals to SNFs or LTCFs with factor and Rasch analyses to examine the clinical utility of the BIMS. More than 40% of the sample had maximum scores, indicating a ceiling effect. “Repetition of three words” was the easiest and the only misfit item (Outfit = 3.14). The ability of the BIMS to distinguish individuals into two cognitive levels (with person strata of 1.48) was limited. Although the BIMS is a widely used screening tool for cognitive impairment, we found it lacked sensitivity for approximately one half of patients admitted to SNFs/LTCFs. Our results suggest the BIMS should be interpreted with caution, particularly for patients with mild cognitive impairment.

Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes

BackgroundU.S. nursing homes provide long-term care to over 1.2 million older adults, 60% of whom were physically frail and 68% had moderate or severe cognitive impairment. Limited research has examined the longitudinal experience of these two conditions in older nursing home residents.MethodsThis national longitudinal study included newly-admitted non-skilled nursing care older residents who had Minimum Data Set (MDS) 3.0 (2014–16) assessments at admission, 3 months, and 6 months (n = 266,001). Physical frailty was measured by FRAIL-NH and cognitive impairment by the Brief Interview for Mental Status. Separate sets of group-based trajectory models were fitted to identify the trajectories of physical frailty and trajectories of cognitive impairment, and to estimate the association between older residents’ characteristics at admission with each set of trajectories. A dual trajectory model was used to quantify the association between the physical frailty trajectories and cognitive impairment trajectories.ResultsOver the course of the first six months post-admission, five physical frailty trajectories [“Consistently Frail” (prevalence: 53.0%), “Consistently Pre-frail” (29.0%), “Worsening Frailty” (7.6%), “Improving Frailty” (5.5%), and “Consistently Robust” (4.8%)] and three cognitive impairment trajectories [“Consistently Severe Cognitive Impairment” (35.5%), “Consistently Moderate Cognitive Impairment” (31.8%), “Consistently Intact/Mild Cognitive Impairment” (32.7%)] were identified. One in five older residents simultaneously followed the trajectories of “Consistently Frail” and “Consistently Severe Cognitive Impairment”. Characteristics associated with higher odds of the “Improving Frailty”, “Worsening Frailty”, “Consistently Pre-frail” and “Consistently Frail” trajectories included greater at-admission cognitive impairment, age ≥ 85 years, admitted from acute hospitals, cardiovascular/metabolic diagnoses, neurological diagnoses, hip or other fractures, and presence of pain. Characteristics associated with higher odds of the “Consistently Moderate Cognitive Impairment” and “Consistently Severe Cognitive Impairment” included worse at-admission physical frailty, neurological diagnoses, hip fracture, and receipt of antipsychotics.ConclusionsFindings provided information regarding the trajectories of physical frailty, the trajectories of cognitive impairment, the association between the two sets of trajectories, and their association with residents’ characteristics in older adults’ first six months post-admission to U.S. nursing homes. Understanding the trajectory that the residents would most likely follow may provide information to develop a comprehensive care approach tailored to their specific healthcare goals.

Standardized assessment of cognitive function of post‐acute care patients

The assessment of cognitive function in post-acute care (PAC) settings is important for understanding an individual's condition and care needs, developing better person-directed care plans, predicting resource needs and understanding case mix. Therefore, we tested the feasibility and reliability of cognitive function assessments, including the Brief Interview for Mental Status (BIMS), Confusion Assessment Method (CAM©), Expression and Understanding, and Behavioral Signs and Symptoms for patients in PAC under the intent of the IMPACT Act of 2014. We conducted a national test of assessments of four standardized cognitive function data elements among patients in PAC. One hundred and forty-three PAC settings (57 home health agencies, 28 inpatient rehabilitation facilities, 28 long-term care hospitals, and 73 Skilled Nursing Facilities) across 14 U.S. markets from November 2017 to August 2018. At least one of four cognitive function data elements were assessed in 3026 patients. We assessed descriptive statistics, percent of missing data, time to complete, and interrater reliability between paired research nurse and facility staff assessors, and assessor feedback. The BIMS, CAM©, Expression and Understanding, and Behavioral Signs and Symptoms demonstrated low rates of missing data (less than 2%), high percent agreement, and substantial support from assessors. The prevalence of Behavioral Signs and Symptoms was low in our sample of PAC settings. Findings provide support for feasibility of implementing standardized assessment of all our cognitive function data elements for patients in PAC settings. The BIMS and CAM© were adopted into federal Quality Reporting Programs in the fiscal year/calendar year 2020 final rules. Future work could consider implementing additional cognitive items that assess areas not covered by the BIMS and CAM©.

No rest for the weary: Prevalence, impact and nature of sleep problems among young people at risk of psychosis.

Sleep problems are common in people with a psychosis-spectrum diagnosis and are associated with worse psychotic symptoms and lower quality of life. Sleep problems are also frequent in individuals at a clinical high risk for psychosis (CHR-P) however, less is known about the prevalence and association with symptoms in this population. This study investigates the prevalence of sleep problems within CHR-P individuals and the associations with attenuated positive symptoms, transition to psychosis, time to transition to psychosis and functioning. The clinical records interactive search (CRIS) tool was used to carry out a retrospective study of 795 CHR-P individuals. Sleep problems, subsequent psychotic diagnoses, attenuated positive symptoms and Health of The Nation Outcome Scale scores were extracted. Regression models were used to examine the association between sleep problems and clinical outcomes. 59.5% of CHR-P individuals experienced sleep problems. Perceptual abnormality severity (OR=1.24, 95% CI=1.05-1.48) and frequency (OR=1.31, 95% CI=1.08-1.58) as measured by the Comprehensive Assessment of At-Risk Mental State interview, predicted sleep problems. Sleep problems were not associated with transition to psychosis; however, they were significantly associated with a shorter time to transition in individuals who developed psychosis (HR=1.4, 95% CI=1.05-1.88) and higher follow-up Health of the Nation Outcome Scale scores (MD=2.26, 95% CI=0.55-3.96). The high prevalence of sleep problems, along with the association with positive symptoms and worse functioning, highlights the need for effective sleep interventions in this population. Further research is needed to better understand the relationship between sleep problems and transition to psychosis.

The Relationship Between Pain, Function, Behavioral, and Psychological Symptoms of Dementia and Quality of Life

BackgroundThis study evaluated the association between age, sex, comorbidities, cognition, and administration of opioids with pain and the impact of all of these variables plus function, agitation, resistiveness to care, and depression on quality of life among residents in nursing home with severe dementia. DesignThis was a descriptive study using baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia implementation study. MethodsModel testing was done using structural equation modeling. The sample included 553 residents from 55 nursing homes with a mean age of 83.88 (standard deviation = 10.44) and mean Brief Interview of Mental Status of 4.30 (standard deviation = 3.50). ResultsThere were significant associations showing those who were older, male, had fewer comorbidities, better cognition, and were black were more likely to have pain. Pain, in combination with the demographic and descriptive variables, explained 32% of the variance in function, 75% of the variance in depression, 88% of the variance in agitation, 98% of the variance in resistiveness to care, and 92% of the variance in quality of life. The model however did not show a good fit to the data. SettingThe study was done in 55 nursing homes in Maryland and Pennsylvania. Participants/SubjectsA total of 553 residents were included in the study. ConclusionsThe model did not have a good fit with the data which likely was due to the lack of variance in outcomes. The hypothesized paths, with the exception of opioid use, were significant.

Physical Frailty and Cognitive Impairment in Older Adults in United States Nursing Homes

Introduction: In older US nursing home (NH) residents, there is limited research on the prevalence of physical frailty, its potential dynamic changes, and its association with cognitive impairment in older adults’ first 6 months of NH stay. Methods: Minimum Data Set (MDS) 3.0 is the national database on residents in US Medicare-/Medicaid-certified NHs. MDS 3.0 was used to identify older adults aged ≥65 years, newly admitted to NHs during January 1, 2014, and June 30, 2016, with life expectancy ≥6 months at admission and NH length of stay ≥6 months (N = 571,139). MDS 3.0 assessments at admission, 3 months, and 6 months were used. In each assessment, physical frailty was measured by FRAIL-NH (robust, prefrail, and frail) and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale (none/mild, moderate, and severe). Demographic characteristics and diagnosed conditions were measured at admission, while presence of pain and receipt of psychotropic medications were at each assessment. Distribution of physical frailty and its change over time by cognitive impairment were described. A nonproportional odds model was fitted with a generalized estimation equation to longitudinally examine the association between physical frailty and cognitive impairment, adjusting for demographic and clinical characteristics. Results: Around 60% of older residents were physically frail in the first 6 months. Improvement and worsening across physical frailty levels were observed. Particularly, in those who were prefrail at admission, 23% improved to robust by 3 months. At admission, 3 months, and 6 months, over 37% of older residents had severe cognitive impairment and about 70% of those with cognitive impairment were physically frail. At admission, older residents with moderate cognitive impairment were 35% more likely (adjusted odds ratio [aOR]: 1.35, 95% confidence interval [CI]: 1.33–1.37) and those with severe impairment were 74% more likely (aOR: 1.74, 95% CI: 1.72–1.77) to be frail than prefrail/robust, compared to those with none/mild impairment. The association between the 2 conditions remained positive and consistently increased over time. Discussion/Conclusion: Physical frailty was prevalent in NHs with potential to improve and was strongly associated with cognitive impairment. Physical frailty could be a modifiable target, and interventions may include efforts to address cognitive impairment.

How Well Does the Brief Interview for Mental Status Identify Risk for Cognition Mediated Functional Impairment in a Community Sample?

ObjectiveTo determine the adequacy of the Brief Interview for Mental Status (BIMS) compared with other screening tools in identifying individuals with limitations in functional cognition and instrumental activities of daily living (IADL). DesignCross-sectional observational study. SettingMidsized midwestern city. ParticipantsWe assessed a convenience sample of community dwelling individuals (N=197) aged 55 years and older who were living independently. Main Outcome MeasuresParticipant scores on the BIMS, Mini-Cog, Menu Task, and Montreal Cognitive Assessment (MoCA) were compared with the Performance Assessment of Self-Care Skills Checkbook Balancing and Shopping tasks (PCST), which are known to predict impairment in complex IADLs associated with a diagnosis of mild cognitive impairment. Multiple logistic regression analyses controlling for participant demographics, as well as sensitivity and specificity, were computed for each screening measure using the PCST as the criterion measure. ResultsThe Mini-Cog, Menu Task, and MoCA identified 25.89%, 32.49%, and 47.21% more individuals, respectively, as impaired than the BIMS. In multiple logistical regression analyses, the BIMS correctly identified 58% of those impaired on the PCST. However, each of the alternate screening measures correctly identified at least 70% of individuals as impaired on the PCST. ConclusionsIn this community sample, the BIMS was insensitive to subtle impairments with the potential to compromise community living, suggesting that the BIMS may be inappropriate for use outside nursing home settings.

Changes in depressive symptoms and cognitive impairment in older long-stay nursing home residents in the USA: a latent transition analysis

Objectives To longitudinally examine the latent statuses of depressive symptoms and their association with cognitive impairment in older U.S. nursing home (NH) residents. Method Using Minimum Data Set 3.0, newly-admitted, long-stay, older NH residents with depression in 2014 were identified (n = 88,532). Depressive symptoms (Patient Health Questionnaire-9) and cognitive impairment (Brief Interview of Mental Status) were measured at admission and 90 days. Latent transition analysis was used to examine the prevalence of and the transition between latent statuses of depressive symptoms from admission to 90 days, and the association of cognitive impairment with the statuses at admission. Results Four latent statuses of depressive symptoms were identified: ‘Multiple Symptoms’ (prevalence at admission: 17.3%; 90 days: 13.6%), ‘Depressed mood’ (20.0%; 19.5%), ‘Fatigue’ (27.4%; 25.7%), and ‘Minimal Symptoms’ (35.3%; 41.2%). Most residents remained in the same status from admission to 90 days. Compared to residents who were cognitively intact, those with moderate impairment were more likely to be in ‘Multiple Symptoms’ and ‘Fatigue’ statuses; those with severe impairment had lower odds of belonging to ‘Multiple Symptoms’, ‘Depressed Mood’, and ‘Fatigue’ statuses. Conclusion By addressing the longitudinal changes in the heterogeneous depressive symptoms and the role of cognitive impairment, findings have implications for depression management in older NH residents.

Facilitators and Barriers to Attendance in a Nursing Home Exercise Program

SummaryWomen and residents in Certified Nursing Homes (CNHs) with higher star ratings had better attendance in exercise and social engagement programming (ie, Bingocize) than men and residents in CNHs with lower ratings. ObjectiveThe purpose of the current study was to determine whether resident factors and nursing home star ratings influenced attendance in Bingocize, a therapeutic exercise program that incorporates opportunities for social engagement in nursing homes. DesignThis is a descriptive study of data collected across multiple nursing homes over 17 months. Setting and ParticipantsData were collected from residents in 25 certified nursing homes in the mid-southern United States. MethodsThe program consisted of two 45–60-minute sessions each week. Bingocize attendance was recoded as number of sessions attended each month from September 2017 to February 2019 in 25 nursing homes. The impact of gender, age, cognitive functioning, and Nursing Home Star Ratings on adherence to the program based on percentage of Bingocize sessions attended was analyzed. ResultsA total of 1165 residents of certified nursing homes were recruited and participated in Bingocize; 55% of participants attended Bingocize infrequently or had poor attendance, 21% of the participants had average attendance, and 24% had good attendance. The association between gender and level of attendance was significant (P = .045). The star rating of the nursing home also affected attendance. As star level of the nursing home increased, the percentage of good attendance increased (P < .001): 19.12% (1 star), 20.69% (2 stars), 23.57% (3 stars), 33.76% (4 stars), and 36.63% (5 stars). Neither age nor cognitive functioning [based on Brief Interview of Mental Status (BIMS)] had a significant impact on attendance. Conclusions and ImplicationsWe examined adherence to an exercise program called Bingocize based on percentage of sessions attended in 25 nursing homes. Women and residents in nursing homes with higher star ratings were reported to have better attendance in Bingocize than men or residents in nursing homes with lower ratings, respectively. Residents of all ages and cognitive ability can successfully participate in the Bingocize program.

Care Transitions to the Community From Veterans Affairs Nursing Homes: Experiences of Social Connection and Disconnection

ObjectiveThis study aimed to further knowledge of older Veterans’ experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning. DesignA qualitative study design was used in addition to administration of standardized depression and mental status screens. Setting and ParticipantsVeterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York. MethodsSemistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2–4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge. ResultsThematic analysis of verbatim transcriptions revealed 3 inter-related themes: (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans’ expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as “lonely” after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status: range = 14–15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire: mean = 4.9, SD = 6.1, median/mode = 3, range = 0–23). Conclusions and ImplicationsThis study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals.

The process of obtaining informed consent to research in long term care facilities (LTCFs): An Observational Clinical Study.

We examined the process of obtaining informed consent (IC) for clinical research purposes in long-term care facilities (LTCFs) in Rhode Island (RI), USA. We assessed factors that were associated with resident ability to consent, such as Brief Interview for Mental Status scores. We used a self-administered questionnaire to further understand the effect of LTCF staff evaluation of ability to consent on residents' autonomy and control over their medical decision making.Observational clinical studyLong-term care setting.LTCF personnel provided us with residents' names, as well as their professional assessment of resident ability to consent. We used Brief Interview for Mental Status (BIMS) scores to assess the cognitive capacity of all residents to assess, and compare it to the assessment provided by LTCF personnel. A logistic regression analysis was performed to determine the relationship between LTCF assessment of resident ability to consent and BIMS score or confirmed diagnosis of dementia as seen from residents' medical charts. A self-administered questionnaire was filled out by the personnel of 10 LTCFs across RI, USA.LTCF personnel in 9 out of 10 recruited facilities reported that their assessment of resident ability to consent was based on subjective assessment of the resident as alert and oriented. There was a statistically significant relationship between the LTCF assessment of resident ability to consent and previously diagnosed dementia (OR: 0.211, 95% CI 0.107-0.415). Therefore, as BIMS scores increased, the likelihood that the resident would be deemed able to consent by LTCF personnel also increased. Furthermore, there was a statistically significant relationship between LTCF assessment of resident ability to consent and BIMS scores (OR: 1.430, 95% CI 1.274-1.605).There is no standard on obtaining IC for research studies conducted in LTCFs. We recommend that standardizing the process of obtaining IC in LTCFs can enhance the ability to perform research with LTCF residents.

Depression symptoms and cognitive impairment in older nursing home residents in the USA: A latent class analysis.

To identify subgroups of nursing home (NH) residents in the USA experiencing homogenous depression symptoms and evaluate if subgroups vary by cognitive impairment. We identified 104 465 newly admitted, long-stay residents with depression diagnosis at NH admission in 2014 using the Minimum Data Set 3.0. The Patient Health Questionnaire-9 was used to measure depression symptoms and the Brief Interview of Mental Status for cognitive impairment (intact; moderately impaired; severely impaired). Latent class analysis (LCA) with logistic regression was used to: (a) construct the depression subgroups and (b) estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the associations between the subgroups and cognitive impairment level, adjusting for demographic and clinical characteristics. The best-fitted LCA model suggested four subgroups of depression: minimal symptoms (latent class prevalence: 42.4%), fatigue (32.0%), depressed mood (14.5%), and multiple symptoms (11.2%). Odds of subgroup membership varied by cognitive impairment. Compared to residents with intact cognition, those with moderate or severe cognitive impairment were less likely to belong to the fatigue subgroup [aOR(95% CI): moderate: 0.75 (0.71-0.80); severe: 0.26 (0.23-0.29)] and more likely to belong to the depressed mood subgroup [aOR (95% CI): moderate: 4.54 (3.55-5.81); severe: 6.41 (4.86-8.44)]. Residents with moderate cognitive impairment had increased odds [aOR (95% CI): 1.19 (1.12-1.27)] while those with severe impairment had reduced odds of being in the multiple symptoms subgroup [aOR (95% CI): 0.63 (0.58-0.68)]. Findings provide a basis for improving depression management with consideration of both subgroups of depression symptoms and levels of cognitive function.

Clostridioides Difficile Management in a Patient With Barrett’s Esophagus

Clostridioides Difficile Management in a Patient With Barrett’s Esophagus

VALIDATION OF A NEW FUNCTIONAL COGNITION SCREENING MEASURE

Identification of cognitive deficits that contribute to functional dependence in acute and post-acute care settings is important. The Menu Task (MT) is a brief cognitive 12 item screening measure designed to identify older adults at risk for IADL impairment in community settings. The objective was to compare the psychometric properties of the Menu Task a series of neurocognitive and functional cognitive performance measures including the Brief Interview of Mental Status (BIMS), the Montreal Cognitive Assessment (MoCA) the Weekly Calendar Planning Activity (WCPA) and the Performance Assessment of Self-Care Skills (PASS) in a sample of 200 community dwelling older adults. Participants were administered the MT, BIMS, MoCA, WCPA, and the PASS checkbook and shopping tasks. ROC analysis identified an MT cut score, sensitivity and specificity. We computed Cronbach’s alpha, correlations among study measures and t-tests between groups impaired or unimpaired on the MT. Mean age of participants was 70.44(SD 8.3), the sample was predominately female ((76%), and white (81%). Mean MT score was 8.22 (SD 2.01) and the mean completion time was 185.5 sec (SD 108.11). The Menu Task has moderate internal consistency (α= 0.65). The AUC statistic was 0.83 with an optimal MT cut score of “7” and sensitivity of .90 and specificity of .70. Significant differences (p < 0.01) were observed between impaired and not impaired MT groups on BIMS, MoCA, WCPA, and PASS. The Menu Task has moderate to strong evidence supporting its psychometric properties and the value of screening for functional cognitive deficits.