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

Chodosh, Joshua; Edelen, Maria Orlando; Buchanan, Joan L.; Yosef, Julia; Ouslander, Joseph G.; Berlowitz, Dan R.; Streim, Joel E.; Saliba, Debra

doi:10.1111/j.1532-5415.2008.01944.x

Cited by 129 publications

(90 citation statements)

References 23 publications

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“…The scores from each item are summed to create a total BIMS score ranging from 15 (all items correct) to 0 (no items correct). The BIMS has displayed high levels of sensitivity (94.4%) and specificity (78.6%) in identifying cognitive impairment 7 and has been categorized into 3 levels: intact/borderline cognition (13–15) moderate cognitive impairment (8–12), severe cognitive impairment (0–7). 4,7,8 …”

Section: Methodsmentioning

confidence: 99%

The Minimum Data Set 3.0 Cognitive Function Scale

et al. 2017

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Background The Minimum Data Set (MDS) 3.0 introduced the Brief Interview for Mental Status (BIMS), a short performance-based cognitive screener for nursing home (NH) residents. Not all residents are able to complete the BIMS and are consequently assessed by staff. We designed a Cognitive Function Scale (CFS) integrating self-report and staff-report data and present evidence of the scale’s construct validity. Design Retrospective cohort study. Subjects Consisted of three cohorts: 1) long-stay NH residents (N=941,077) and 2) new admissions (N=2,066,580) during 2011–2012, and 3) residents with the older MDS 2.0 assessment in 2010 and the newer MDS 3.0 assessment (n=688,511). Measures MDS 3.0 items were used to create a single, integrated four-category hierarchical CFS that was compared to residents’ prior MDS 2.0 Cognitive Performance Scale scores and other concurrent MDS 3.0 measures of construct validity. Results The new CFS suggests that 28% of the long-stay cohort in 2011–2012 were cognitively intact, 22% were mildly impaired, 33% were moderately impaired, and 17% were severely impaired. For the admission cohort, the CFS noted 56% as cognitively intact, 23% as mildly impaired, 17% as moderately impaired, and 4% as severely impaired. The CFS corresponded closely with residents’ prior MDS 2.0 Cognitive Performance Scale scores and with performance of Activities of Daily Living, and nurses’ judgments of function and behavior in both the admission and long-stay cohorts. Conclusion The new CFS is valuable to researchers as it provides a single, integrated measure of NH residents’ cognitive function, regardless of the mode of assessment.

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Section: Methodsmentioning

confidence: 99%

The Minimum Data Set 3.0 Cognitive Function Scale

et al. 2017

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“…Cognitive status was measured using the validated MDS 3.0 Brief Interview for Mental Status (BIMS), 8 which was present for 69 % of residents, supplemented when missing with the staff assessment for 26 % or an indication that the resident was comatose (0.4 %). Using this combined variable, cognitive impairment was defined as none (BIMS score [13][14][15] or not impaired by staff assessment), mild to moderate (BIMS score 8-12), or severe (BIMS score 0-7 or impaired by staff assessment or comatose).…”

Section: Methodsmentioning

confidence: 99%

Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents

Jennings

Zingmond²,

Louie³

et al. 2016

J GEN INTERN MED

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BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) is a tool that facilitates the elicitation and continuity of life-sustaining care preferences. POLST was implemented in California in 2009, but how well it disseminated across a large, racially diverse population is not known and has implications for end-of-life care. OBJECTIVE: To evaluate the use of POLST among California nursing home residents, including variation by resident characteristics and by nursing home facility. DESIGN: Observational study using California Minimum Data Set Section S. PARTICIPANTS: A total of 296,276 people with a stay in 1,220 California nursing homes in 2011. MAIN MEASURES:The proportion of residents with a completed POLST (containing a resuscitation status order and resident/proxy and physician signatures) and relationship to resident characteristics; change in POLST use during 2011; and POLST completion and unsigned forms within nursing homes. KEY RESULTS: During 2011, POLST completion increased from 33 to 49 % of California nursing home residents. Adjusting for age and gender using a mixed-effects logistic model, long-stay residents were more likely than short-stay residents to have a completed POLST [OR = 2.36 (95 % CI 2.30, 2.42)]; severely cognitively impaired residents were less likely than unimpaired to have a completed POLST [OR = 0.89 (95 % CI 0.87, 0.92)]; and there was little difference by functional status. There was no difference in POLST completion among White non-Hispanic, Black, and Hispanic residents. Variation in POLST completion among nursing homes far exceeded that attributable to resident characteristics with 40 % of facilities having ≥80 % of long-stay residents with a completed POLST, while 20 % of facilities had ≤10 % of long-stay residents with a completed POLST. Thirteen percent of nursing home residents had a POLST containing a resuscitation preference but lacked a signature, rendering the POLST invalid. CONCLUSIONS: Statewide nursing home data show broad uptake of POLST in California without racial disparity. However, variation in POLST completion among nursing homes identifies potential areas for quality improvement.KEY WORDS: end-of-life care; nursing home; long-term care; quality improvement. J Gen Intern Med 31(10):1119-26 DOI: 10.1007/s11606-016-3728-9 © Society of General Internal Medicine 2016 INTRODUCTIONPhysician Orders for Life-Sustaining Treatment (POLST) facilitates elicitation of life-sustaining treatment preferences from patients and is designed to improve the transition of these preferences, in the form of physician orders, across care settings. POLST captures preferences concerning cardiopulmonary resuscitation, overall aggressiveness of care, hospital transfer, and artificial nutrition. 1 The document is particularly useful for residents of nursing facilities because many residents live in compromised health states and would not desire burdensome treatments 2 and also because it is common for nursing home residents to transition to the emergency room and the hospital 3 wh...

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“…Results from the studies conducted with veterans, indicated excellent convergent and criterion validity with other measures frequently used to screen for cognitive impairment in long-term care and improved psychometric properties over the cognitive measure used in the prior version of the MDS (Chodosh, 2008). Subsequent research involving 71 community long-term care facilities with a population similar to the sample collected for the present study replicated these findings .…”

Section: Limitationssupporting

confidence: 64%

“…The BIMS is brief measure of global cognitive functioning originally developed in Veterans Affairs Hospital extended care facilities (Chodosh, 2008). Results from the studies conducted with veterans, indicated excellent convergent and criterion validity with other measures frequently used to screen for cognitive impairment in long-term care and improved psychometric properties over the cognitive measure used in the prior version of the MDS (Chodosh, 2008).…”

Section: Limitationsmentioning

confidence: 99%

Anxiety in older adults with dementia residing in long-term care facilities.

Hess¹

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

Abstract: 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.

Cited by 129 publications

References 23 publications

The Minimum Data Set 3.0 Cognitive Function Scale

The Minimum Data Set 3.0 Cognitive Function Scale

Use of the Physician Orders for Life-Sustaining Treatment among California Nursing Home Residents

Anxiety in older adults with dementia residing in long-term care facilities.

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