Assessing Cognitive Function
Protocol 8.1: Assessing Cognitive Functioning (cont.)
(continued)
iii. Immediately before and after medical diagnostic or therapeutic pro- cedures
iv. In the presence of pain or discomfort V. EVALUATION/ExPECTED OUTCOMES
A. Patient
1. Is assessed at recommended time points 2. Any impairment detected early
3. Care tailored to appropriately address cognitive status/impairment 4. Satisfaction with care improved
B. Health Care Provider
1. Competent to assess cognitive function
2. Able to differentiate among delirium, dementia, and depression 3. Uses standardized cognitive assessment protocol
4. Satisfaction with care improved C. Institution
1. Improved documentation of cognitive assessments
2. Impairments in cognitive function identified promptly and accurately 3. Improved referral to appropriate advanced providers (e.g., geriatricians,
geriatric nurse practitioners) for additional assessment and treatment rec- ommendations
4. Decreased overall costs of care VI. FOLLOW-UP MONITORING
A. Provider competence in the assessment of cognitive function B. Consistent and appropriate documentation of cognitive assessment C. Consistent and appropriate care and follow-up in instances of impairment D. Timely and appropriate referral for diagnostic and treatment recommendations VII. RELEVANT PRACTICE GUIDELINES
A. The Registered Nurse Association of Ontario Best Practice Guideline for Screening for Delirium, Dementia and Depression in Older Adults. Retrieved from http://rnao.org/Page.asp?PageID=924&ContentID=818
B. Guidelines and Protocols Advisory Committee (GPAC) guideline. Cognitive impairment in the elderly—recognition, diagnosis, management. Retrieved from http://www.bcguidelines.ca/gpac/guideline_cognitive.html
C. National Institute for Health and Clinical Excellence (NICE) guideline. Delir- ium: diagnosis, prevention and management. Retrieved from http://guidance.
nice.org.uk/CG103
D. The National Guideline Clearinghouse. Delirium, dementia, amnestic, cog- nitive disorders. Retrieved from http://www.guideline.gov/browse/by-topic- detail.aspx?id=13949
Protocol 8.1: Assessing Cognitive Functioning (cont.)
ResOURces
Recommended Instruments for Assessing Cognitive Functioning Mini-Cog
http://www.nursingcenter.com/prodev/ce_article.asp?tid=756614 Mini-Mental State
http://www.minimental.com Sweet 16
http://www.hospitalelderlifeprogram.org
Additional Online Information About Assessing Cognitive Functioning The Iowa Index of Geriatric Assessment Tools (IIGAT)
http://www.healthcare.uiowa.edu/igec/tools/
“Try This”
A series of tips on various aspects of assessing and caring for older adults sponsored by the Hartford Institute for Geriatric Nursing at New York University College of Nursing.
http://www.consultgerirn.org
The Registered Nurse Association of Ontario Best Practice Guideline for Screening for Delirium, Dementia and Depression in Older Adults.
http://rnao.org/Page.asp?PageID=924&ContentID=818 Geriatric Toolkits
http://www.gericareonline.net/tools/index.html ICU Delirium and Cognitive Impairment Study Group http://www.icudelirium.org
Assessing care of vulnerable elders (ACOVE) http://www.rand.org/health/projects/acove.html
RefeRences
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R. (2004). Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: A survey of 912 healthcare professionals. Critical Care Medicine, 32(1), 106–112. Evidence Level IV.
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135 eDUcATIOnAL OBjecTIVes
On completion of this chapter, the reader should be able to:
1. discuss the major risk factors for late-life depression 2. discuss the consequences of late-life depression
3. identify the core competencies of a systematic nursing assessment for depression with older adults
4. identify nursing strategies for older adults with depression OVeRVIeW
Contrary to popular belief, depression is not a normal part of aging. Rather, depression is a medical disorder that causes suffering for patients and their families, interferes with a person’s ability to function, exacerbates coexisting medical illnesses, and increases use of health services (Lebowitz, 1996). Despite the efficacious treatments available for late-life depression, many older adults lack access to adequate resources; barriers in the health care reimbursement system are particular challenges for low income and ethnic minority older adults (Charney et al., 2003). In a comprehensive review of research on the prevalence of depression in later life, Hybels and Blazer (2003) found that although major depressive disorders are not prevalent in late life (1%–5%), the prevalence of clinically significant depressive symptoms is high (3%–30%). What is more, these depressive symptoms are associated with higher morbidity and mortality rates in older adults than in younger adults (Bagulho, 2002; Lyness et al., 2007).
The rates of depressive symptoms vary, depending on the population of older adults:
community-dwelling older adults (3%–26%), primary care (10%), hospitalized older adults (23%), and nursing home residents (16%–30%; Hybels & Blazer, 2003).
Certain subgroups have higher levels of depressive symptoms, particularly those with more severe or chronic disabling conditions, such as those older people in acute