Annals of Long Term Care

Brief Reports

Nursing Home Assessment of Cognitive Impairment: Development and Testing of a Brief Instrument of Mental Status

Joshua Chodosh, MD, MSHS, Maria Orlando Edelen, PhD, Joan L. Buchanan, PhD, Julia Ann Yosef, MS, Joseph G. Ouslander, MD, Dan R. Berlowitz, MD, MPH, Joel E. Streim, MD, and Debra Saliba, MD, MPH

OBJECTIVES: To test the accuracy of a brief cognitive assessment of nursing home (NH) residents and to determine whether facility nurses can reliably perform this assessment.

DESIGN: Cross-sectional, independent cognitive screening tests with NH residents.

SETTING: Six Department of Veteran Affairs nursing facilities.

PARTICIPANTS: Three hundred seventy-four residents from six regionally distributed Veteran Affairs NHs.

MEASUREMENTS: Three cognitive assessment instruments: the Brief Interview of Mental Status (BIMS), created for this study; the Minimum Data Set (MDS) 2.0 Cognitive Performance Scale (CPS), and the Modified Mini-Mental State Examination (3MS) as the criterion standard. The 15-point BIMS tests memory and orientation and includes free and cued recall items. Research assistants administered the 3MS and BIMS to all subjects. Facility nurses administered the same BIMS to a subsample.

RESULTS: Three hundred seventy-four of 417 (89.7%) residents approached completed the 3MS and research assistant–administered BIMS (BIMS-R); 212 residents also received a facility nurse–administered BIMS (BIMS-N). The BIMS-R was more highly correlated with the 3MS than was the CPS (Pearson correlation coefficient (r)=0.79 vs 0.62; P<.01 for difference). For the subset who received facility assessments, the BIMS-N was also more highly correlated with the 3MS (Pearson r=0.74 vs 0.65; P<.01 for difference). For any impairment (3MS<78), the area under the receiver operator characteristic curve (AUC) was 0.86 for the BIMS, versus 0.77 for the CPS. For severe impairment (3MS<48) the AUC was 0.94, versus 0.85 for the CPS.

CONCLUSION: In this population, a brief cognitive test is a more accurate approach to cognitive assessment than the current observational methods employed using the MDS 2.0. J Am Geriatr Soc 2008;56(11):2069-2075.

Physician Recommendations for Mammography in Women Aged 70 and Older

Julie M. Kapp, MPH, PhD, Joseph W. LeMaster, MD, MPH, Steven C. Zweig, MD, MSPH, and David R. Mehr, MD, MS

OBJECTIVES: To estimate the percentage of U.S. women aged 70 and older who reported a recent mammography recommendation and to identify whether factors suggesting limited life expectancy, such as comorbidities, are associated with a lower probability of a reported recommendation.

DESIGN: A national, population-based, cross-sectional survey.

SETTING: United States.

PARTICIPANTS: There were 1,782 screen-eligible women 70 and older who responded to the National Health Interview Survey in 2005 and met eligibility criteria, including reporting at least one doctor visit in the previous 12 months. Weighted, these women represented almost 9.3 million women nationally.

MEASUREMENTS: Multiple logistic regression was used to examine the relationship between demographic, comorbidity, and health services utilization variables on self-reported physician recommendation for a mammogram.

RESULTS: More than half (58.9%) of the sample reported a recent mammography recommendation (63.0% of those aged 70 to 79 and 51.5% of those aged 80 and older). The strongest multivariable association suggested that women who reported a recent clinical breast examination (CBE) had 5.9 times greater odds of reporting a mammography recommendation than women who reported never having a CBE.