Detecting Cognitive Change in the Hospitalized Elderly

Wednesday, 15 July 2009: 10:45 AM

Margarete Lieb Zalon, PhD, RN, ACNS-BC
Department of Nursing, University of Scranton, Scranton, PA
Sonia Sandhaus, MSN, RNC, CRNP
HELP Program, Moses Taylor Hospital, Scranton, PA
Donna Valenti, RNC
Hospital Elder Life Program, Moses Taylor Hospital, Scranton, PA
Ulyana Arzamasova, BA
Elder Life Program, Moses Taylor Hospital, Scranton, PA

Learning Objective 1: To understand how bedside assessment can be used to detect cognitive decline in the hospitalized elderly.

Learning Objective 2: To learn how personal digital assistant (PDA) technology can be used to collect data for bedside assessment.

Delirium in the hospitalized elderly is a complex problem, complicating hospital stay, resulting in functional decline, greater likelihood of nursing home placement and even mortality.  Our goal is to facilitate the translation of research into practice with the development of an electronic data collection methodology for use in a program designed to prevent delirium and cognitive decline in hospitalized elders. The aim is to evaluate mental status assessments to monitor delirium in a community hospital that is using the Hospital Elder Life Program (HELP) (©, Inouye, 1999). This program uses trained volunteers to deliver standardized interventions to patients aged 70 years and older including orientation, therapeutic activities, relaxation techniques, simple exercise for mobilization, vision and hearing aids and assistance with feeding. The initial phase of our project included the development and testing of a user-friendly personal digital assistant (PDA) version of the Mini-Mental Status Examination (MMSE) (Folstein, et al., 1975) and the Confusion Assessment Method (CAM) (Inouye, 1991) which were then downloaded to a computer. Data were collected over a 4-month period. Patients over the age of 70 were screened by the HELP nursing staff upon enrollment into the program. The sample consisted of 352 patients, 124 men and 228 women. The mean age was 82.3 years. The mean MMSE for the first administration was 22.8 and for the second administration it was 23.4. The CAM score indicated that 16.5% of the patients were experiencing delirium. The results provide preliminary evidence that patients enrolled in the HELP program had a slight improvement in cognitive status. This demonstrates that the HELP program is successful in preventing cognitive decline. PDA use requires careful planning and testing. Using PDAs has enabled us to systematically quantify patient outcomes. Future plans include tracking of HELP program interventions in relation to outcomes.