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Description for Cognitive Performance Scale (CPS) score and the Mini-mental state examination (MMSE) equivalence
Source publication
Objectives
This study aims to determine the prevalence of potentially undetected dementia among institutional care facility residents in Ontario, Canada, and to identify factors associated with undetection.Methods
We utilized a population-based secondary data analysis approach, pertaining to data from the Canadian Institute for Health Information's...
Context in source publication
Context 1
... score describes the cognitive status of a resident. (Table 2) In addition to residents' CPS and ADL scores, inde- pendent variables extracted also included basic demo- graphic variables (age, sex, marital status, and family income), social environment variables (types of facilities and engagement level), and health-related variables (sensory, non-psychiatric, and psychiatric illnesses). The latter are of particular interest as there has been evidence to suggest that psychiatric illness delays cancer diagnosis (O'Rourke et al., 2008) as well as the association between CI and comorbidity ( Tay et al., 2006;Duthie et al., 2011;Freitas et al., 2012;Wallin et al., 2012). ...
Similar publications
To compare the levels of cognitive function at the time of diagnosis among institutional care facility residents with dementia, who were diagnosed either before or after admission to a facility in Ontario, Canada.
The study utilized a population-based secondary data analysis approach, using data from the Canadian Institute for Health Information's...
Citations
... The inclusion criteria specified CPS scores between 0 (indicating no cognitive impairment) and 2 (indicating mild impairment) or between 30 (indicating no cognitive impairment) and 16 (indicating mild impairment) on the MMSE (Wellens et al., 2013). All MMSE scores were converted to the equivalent validated CPS scores (Wellens et al., 2013;Bartfay et al., 2013). ...
Background
Oral health is associated with general health and care dependency, but is often neglected in nursing homes. Integration of oral care into general care is necessary, but is hampered by multiple barriers at different levels. This study is part of research into the implementation of the new Oral Health Section for use within the interRAI Long-Term Care Facilities instrument, which is used to assess care needs of nursing home residents. This new Oral Health Section evaluates nine aspects of oral health and results in two Collaborative Action Points.
Objective
To identify residents' perspectives on oral health, oral care, and on the assessment of their oral health using the new Oral Health Section
Design
Qualitative design using in-depth interviews.
Setting(s)
Three nursing homes
Participants
Residents were selected using purposeful sampling in nursing homes participating in research evaluating the use of the new Oral Health Section. The selection was based on their oral status for maximum variation and on their cognitive performance score. Twenty-two residents from three Flemish nursing homes agreed to participate.
Methods
Residents’ oral health was assessed using the new Oral Health Section and dental indices. In-depth interviews were conducted, including the validated short-form Oral Health Impact Profile to evaluate the impact of oral conditions on residents’ well-being. The interviews were coded and analysed by three researchers and mapped into a model to understand participants’ oral health behaviours.
Results
Low Oral Health Impact Profile scores indicated a low impact of oral health issues on participants’ lives. However, despite 77.3 % of the participants reporting satisfaction with their oral health, 86.4 % had poor oral hygiene and 68.2 % required referral to a dentist, suggesting a tendency to overestimate their oral health. Their oral health behaviour was determined by a lack of oral health knowledge (Capability), positive attitudes towards oral health and autonomy (Motivation), upbringing and social support (Opportunity). Participants considered assessments with the new Oral Health Section acceptable.
Conclusions
This study shows how older people perceive their oral health and oral healthcare. Understanding their wishes and needs will not only facilitate their involvement in their oral care, but is also likely to enable the improvement of their oral hygiene and the development of effective oral care strategies for the future. Policy makers and managers of care organisations may use these results to foster integration of oral care guidelines into care protocols within nursing homes, including collaboration with dentists and dental hygienists.
Tweetable abstract
Oral health assessments with the new Oral Health Section for use within interRAI were positively perceived by nursing home residents.
... 3 Approximately 64% of nursing home residents live with moderate to severe cognitive impairment, and this rate is underestimated by at least 10%. 5 Pain assessment and management are particularly challenging for this population. 6,7 Cognitive impairment inhibits residents' ability to verbally communicate pain and the effectiveness of pain management interventions. ...
Background:
Inadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and residents' pain levels.
Methods:
We performed a cross-sectional analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. We linked administrative data (the Resident Assessment Instrument-Minimum Data Set [RAI-MDS], 2.0) for 10,093 residents and survey data for 3547 nursing assistants (response rate: 74.2%) at the care unit level. Outcome of interest was residents' pain level, measured by the pain scale derived from RAI-MDS, 2.0. The exposure variable was nursing assistants' use of best practices, measured with validated self-report scales and aggregated to the unit level. Two-level random-intercept multinomial logistic regression accounted for the clustering effect of residents within care units. Covariates included resident demographics and clinical characteristics and characteristics of nursing assistants, unit, and nursing home.
Results:
Of the residents, 3305 (30.3%) were identified as having pain. On resident care units with higher levels of best practice use among nursing assistants, residents had 32% higher odds of having mild pain (odds ratio, 1.32; 95% confidence interval, 1.01-1.71; p = 0.040), compared with residents on care units with lower levels of best practice use among nursing assistants. The care units did not differ in reported moderate or severe pain among residents.
Conclusions:
We observed that higher unit-level best practice use among nursing assistants was associated with mild resident pain. This association warrants further research to identify key individual and organizational factors that promote effective pain assessment and management.
... In relation to recruitment procedures, we excluded 133 people from the study (47% of the total population assessed) who did not have a dementia diagnosis. The prevalence of people living with dementia in care homes is at least 69% in Canada (Canadian Institute for Health Information (CIHI)., 2022), but a variety of social factors and co-morbid conditions lead to underdiagnosis (Bartfay et al., 2013). After establishing that Connecting Today works for people living with dementia (in a Phase 3 trial), future (Phase 4) implementation studies could assess the adaptations and effects of Connecting Table 4. Features of calls, resident attendance, and mood during calls. ...
Objectives:
Social isolation and loneliness affect the quality of life of people living with dementia, yet few interventions have been developed for this population. The purpose of this study was to assess the feasibility and acceptability of 'Connecting Today', a remote visiting program designed for use with care home residents living with dementia.
Methods:
This was a feasibility study to assess whether Connecting Today can be delivered in care homes, and was acceptable to family and friends and people living with dementia. We used a single-group before/after design and included residents ≥ 65 years old with a dementia diagnosis from two care homes in Alberta, Canada. Connecting Today involved up to 60 min per week of facilitated remote visits for 6 weeks. To understand feasibility, we assessed rates and reasons for non-enrollment, withdrawal and missing data. We assessed acceptability with the Observed Emotion Rating Scale (residents) and a Treatment Perception and Preferences Questionnaire (family and friends). Data were analyzed with descriptive statistics.
Results:
Of 122 eligible residents, 19.7% (n = 24) enrolled (mean age = 87.9 years, 70.8% females). Three residents withdrew from the study before the first week of calls. Among 21 remaining residents, 62%-90% completed at least 1 call each week. All the calls were completed by videoconference, rather than by phone. Alertness and pleasure were observed for ≥92% of residents during calls. The 24 contacts rated Connecting Today as logical, effective and low risk.
Conclusions:
Facilitated, remote visits are feasible and highly acceptable to residents and their family and friend contacts. Connecting Today shows promise to address social isolation and loneliness for people living with moderate to severe dementia because it can promote positive engagement in meaningful interactions with their family and friends while they are living in a care home. Future studies will test effectiveness of Connecting Today in a large sample.
... Participants in some studies were not diagnosed with subtypes of dementia, which may be attributed to the fact that these interventions were conducted at long-term care facilities or the community, not at a medical institution. Previous studies have indicated that older adults living in long-term care facilities or the community often do not receive a formal diagnosis of dementia even if they show clear cognitive impairment (Bartfay et al., 2013;Lang et al., 2017). However, the features of BPSD depend on the difference in the dementia subtypes (Kazui et al., 2016). ...
Apathy and depression are frequently observed as behavioral and psychological symptoms of dementia, respectively, and are important for ensuring adequate care. This study aims to explore effective non-pharmacological interventions for apathy and depression with mild cognitive impairment (MCI) and dementia. Five search engines including PubMed, Scopus, CINAHL, PsycInfo, and Web of Science were used to extract relevant studies. Inclusion criteria were studies that involved participants who were diagnosed with MCI or dementia, included quantitative assessments of each symptom, and employed randomized controlled trials. Twenty studies were extracted, with interventions have been conducted in care facilities, the community, and hospitals. Participants in many studies had MCI or mild-to-moderate dementia but were not diagnosed with the subtypes of dementia. Few studies had set apathy and depression as the primary outcomes of non-pharmacological interventions. The findings suggested that emotional and stimulation-oriented approaches to apathy and depression would be useful for people with MCI or mild-to-moderate dementia. It would be helpful for therapists to assess the clinical features of the target symptoms for selecting suitable interventions. Additionally, increasing the number of randomized controlled trials focusing on apathy or depression as primary outcomes would offer a more definite conclusion for future systematic reviews.
... There have been many studies on the effect of depression on cognition and daily life ability. 51,52 Interestingly, our study found that schizophrenic patients with depressive symptoms had significantly lower psychiatric symptoms. Because the depressive symptoms and negative symptoms of patients with schizophrenia can often overlap, 53 we are unable to explain whether the above conclusion is an objective truth or an accidental phenomenon. ...
Purpose:
To investigate the prevalence, influencing factors, and cognitive characteristics of depressive symptoms in elderly patients with chronic schizophrenia.
Patients and methods:
A total of 241 elderly patients with chronic schizophrenia and 156 healthy controls were enrolled in this study. The Geriatric Depression Scale (GDS) was used to assess depressive symptoms; the Positive and Negative Syndrome Scale was used to assess psychotic symptoms; and both the Mini-Mental State Examination and Montreal Cognitive Assessment were used to assess overall cognitive function, while the Activity of Daily Living Scale was used to assess daily living ability.
Results:
The prevalence of depressive symptoms was 48.5% (117/241) in elderly patients with chronic schizophrenia, which was substantially higher than that of normal controls (17.3%, 27/156). Using a stepwise binary logistic regression analysis, we found that high education (p=0.006, odds ratio [OR]=1.122, 95% confidence interval [CI]:1.034-1.218) and hypertension (p=0.019, OR=0.519, 95% CI: 0.300-0.898) were influencing factors for the comorbidity of depressive symptoms. Compared with individuals without depressive symptoms, individuals with depressive symptoms usually display worse overall cognitive function and more severe impairment of activities of daily living, but fewer psychotic symptoms. Interestingly, the GDS score was negatively correlated with the course of the disease (r=-0.157, p=0.016), suggesting that patients who had recently been admitted to the hospital were more likely to develop depression.
Conclusion:
Elderly patients with chronic schizophrenia are often associated with higher levels of depression. Therefore, their overall cognitive function is worse, and their activities of daily living are more seriously impaired. Therefore, these patients should be provided with appropriate psychological comfort, especially those who have recently been admitted to the hospital.
... Antidementia drugs might possibly be avoided in patients with dementia who have high comorbidity and, subsequently, short life expectancy due to the risk of side effects. Another possible explanation might be that a large number of NH Regression coefficient (SE) reported because of interaction residents with psychiatric and somatic comorbidity have a potentially undetected dementia [49], leading physicians not to prescribe antidementia drugs to this group of patients. We found that patients with a higher degree of apathy were less likely to be prescribed antidementia drugs. ...
Background
In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription.
Methods
We used data from the Resource Use and Disease Course in Dementia – Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period.
Results
PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%–42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92–0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85–0.94, p < 0.001).
Conclusions
PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs.
Trial registration
ClinicalTrials.gov Identifier: NCT01920100.
... Compared to previous generations, residents who live in nursing homes have increasingly complex care needs (Hoben et al., 2019). For example, approximately two-thirds of residents have a diagnosis of dementia (Danila et al., 2014), and among those without a dementia diagnosis, approximately 36% have mild to moderate impairments and nearly 12% have severe or very severe impairments in cognitive function and do not have adequate ability to perform activities of daily living (Bartfay et al., 2013). ...
Introduction
Health care aides (personal support workers and nursing assistants) provide ~80%–90% of direct care to residents in nursing homes; it is therefore important to understand whether supervision of health care aides affects quality of care. We sought to determine whether health care aide reporting practices are associated with resident outcomes in nursing homes.
Design and Methods
We conducted a cross-sectional secondary analysis of survey data of 3991 health care aides from 322 units in 89 nursing homes in Western Canada. We then linked resident data from the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 database to care aide surveys at the unit level. We used hierarchical mixed models to determine if the proportion of health care aides reporting to a respective nursing leader role was associated with 13 practice sensitive quality indicators of resident care.
Results
Most health care aides reported to a registered nurse (RN, 44.5%) or licenced practical nurse (LPN, 53.3%). Only 2.2% of health care aides reported to a care manager and were excluded from the analysis. Resident outcomes for only declining behavioural symptoms were more favourable when a higher proportion of health care aides (on a unit) reported to RNs, β = −0.004 (95% CI −0.006, −0.001, p = .004). The remaining indicators were not affected by care aide reporting practices.
Discussion and Implications
Resident outcomes as evaluated by the indicators appear largely unaffected by care aide reporting practices. LPNs’ increasing scope of practice and changing work roles and responsibilities in nursing homes across Western Canada may explain the findings.
... 32 Fourth, with the DEMQOL-CH, 30 a version is now available that can be completed by staff caring for residents with dementia living in congregate care settings such as nursing homes or assisted/supportive living. This is important because the majority of these residents have dementia that is severe enough to limit their ability to self-report, [33][34][35][36][37][38] and often residents do not have a family/friend carer who visits and who could provide a proxy assessment. 39 A tool that can be completed by care staff in a way that is reliable, valid, feasible, acceptable and appropriate opens the possibility of routine HRQoL assessment-an important prerequisite for improving residents' HRQoL. ...
Introduction
Dementia is a public health issue and a major risk factor for poor quality of life among older adults. In the absence of a cure, enhancing health-related quality of life (HRQoL) of people with dementia is the primary goal of care. Robust measurement of HRQoL is a prerequisite to effective improvement. The DEMQOL suite of instruments is considered among the best available to measure HRQoL in people with dementia; however, no review has systematically and comprehensively examined the use of the DEMQOL in research and summarised evidence to determine its feasibility, acceptability and appropriateness for use in research and practice.
Methods and analysis
We will systematically search 12 electronic databases and reference lists of all included studies. We will include systematically conducted reviews, as well as, quantitative and qualitative research studies that report on the development, validation or use in research studies of any of the DEMQOL instruments. Two reviewers will independently screen all studies for eligibility, and assess the quality of each included study using one of four validated checklists appropriate for different study designs. Discrepancies at all stages of the review will be resolved by consensus. We will use descriptive statistics (frequencies, proportions, ranges), content analysis of narrative data and vote counting (for the measures of association) to summarise the data elements. Using narrative synthesis, we will summarise what is known about the development, validation, feasibility, acceptability, appropriateness and use of the DEMQOL. Our review methods will follow the reporting and conduct guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
Ethics and dissemination
Ethical approval is not required as this project does not involve primary data collection. We will disseminate our findings through peer-reviewed publications and conference presentations.
PROSPERO registration number
CRD42020157851.
... Nursing homes are a vital component of the health and social care system, providing 24-h care to people with complex care needs who are unable to live in their own homes. Residents are commonly frail, older, have substantial disability, and up to 70% have a diagnosis of dementia [12][13][14] (which may be underestimated by more than 10% [15]). With an aging population and policy shifts that support people living in their own homes as long as possible, the needs of the nursing home population have become increasingly complex [16]. ...
Background:
Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on goal-setting theory on improving formal staff communication in NHs.
Methods:
This pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (translating research in elder care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4641 care aides and 1693 nurses cared for 8766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on goal-setting theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up.
Results:
Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p = 0.021) and enhanced groups ([0.01; 0.33], p = 0.035). We found no difference in this outcome between the two higher intensity groups.
Conclusions:
Theoretically informed feedback was superior to simple feedback in improving care aides' involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested.
Trial registration:
ClinicalTrials.gov ( NCT02695836 ), registered on March 1, 2016.
... Nursing homes are a vital component of the health and social care system, providing 24-hour care to people with complex care needs who are unable to live in their own homes. Residents are commonly frail, older, have substantial disability, and up to 70% have a diagnosis of dementia [12][13][14] (which may be underestimated by more than 10% [15]). With an aging population and policy shifts that support people living in their own homes as long as possible, the needs of the nursing home population have become increasingly complex [16]. ...
Background: Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on Goal Setting Theory on improving formal staff communication in NHs.
Methods: This pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (Translating Research in Elder Care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4,641 care aides and 1,693 nurses cared for 8,766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on Goal Setting Theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up.
Results: Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2,428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2,387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1,584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p=0.021) and enhanced groups ([0.01; 0.33], p=0.035). We found no difference in this outcome between the two higher intensity groups.
Conclusions: Theoretically informed feedback was superior to simple feedback in improving care aides’ involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested.
Trial registration: ClinicalTrials.gov (NCT02695836), https://clinicaltrials.gov/ct2/show/NCT02695836, registered on March 1, 2016
