When is it
Necessary to
Change Care
Settings?
There are three major factors to consider when you’re wondering if it’s
time to bring in help or seek other living solutions.
1. Safety
2. Ability
3. Engagement
Safety: Primary issue – Does the person’s ability to judge risk and ability
match previous skills & are you comfortable with it?
• How safe is the person where they are? Physically? Cognitively?
Emotionally? Socially? Spiritually?
• Do they still have good judgment? Have they shown changes over
time in this area?
• Do the challenges of being where and how they are match abilities
and interests? What’s new?
• Is the set-up and environment secure enough and stable enough for
them at this point in time?
• What appliances, equipment, or tasks are risky? Are there supports
in place and plans to monitor?
• Have you checked in with other sources and people to verify and
validate your beliefs and feelings?
Ability: Primary issue – Does the person still have the physical, cognitive,
social, and emotional capacity to stay where and how they are?
• Are their balance, coordination, strength, endurance and motor
control skills adequate for demands?
• Are their vision, hearing, sense of touch, pain awareness/responses
OK for what is needed in the setting?
• Are there still people available who the person connects to and
spends time with? Is the time productive?
Engagement: Primary issue – Does the person DO things, not just talk
about doing it? Is their support system in place to keep it going?
• Is the person still able to go where they want to go, have fun, feel
valued and productive, meet spiritual needs, have social contact and
fill their time?
• Is the person able to use systems that exist to DO what they need to
do and want to do? Has this changed over time?
• Is the support system becoming stressed with supporting this
person?
15
2. Mental Status Testing (continued)
presence of dementia versus a delirium or
emotional health problem. Currently, a variety of
tools are available and are used. All are still limited
in their evidence base, however, they are typically
viewed as less time consuming and more clinically
useful than the MMSE. They are also less expensive
and less time consuming than a full neurocognitive
evaluation, which can last more than three hours.
It’s important to be aware of some of the most
commonly used tools. Please keep in mind that
there may be training criteria or specific guidelines
on when and how they are used, as well as who
administers them. Several examples of these
guidelines are: Clock Drawing Test, Mini-Cog Test,
Memory Impairment Screen, Abbreviated Mental
Test, Short Portable Mental Status Questionnaire,
Free and Cued Selective Reminding Test, 7-Minute
Screen, Telephone Interview for Cognitive Status,
and Informant Questionnaire on Cognitive Decline
in the Elderly. Other tools include the Self-
Administered Gero-cognitive Evaluation (SAGE) and
the St. Louis University Mental Status test (SLUMS).
Montreal Cognitive Assessment Test (MOCA): A
recent alternative to the MMSE is the MOCA test,
developed under the auspices of the Canadian
Institutes for Health Research and others. MOCA is
distributed free for clinical or educational use.
There are also tools being developed and tested
that allow for self-administration. This option may
be useful to both encourage the individual to
actively participate in the process as well as offer a
comparison of at home versus office performance.
In all cases the greatest challenge is typically that
there is not a baseline measure of ability available
for ready comparison and at this time the only
time most individuals are screened is when the
symptoms are already marked.
Geriatric depression is widespread and older
adults with depression often report problems
with memory. Some studies have found that a
subjective sense of memory loss may be more
closely linked to depression than to dementia.
Many experts recommend that a standard workup
for cognitive problems include screening for
depression. Additionally, the Geriatric Depression
Scale Short Form is a widely used screening tool
that’s recommended.
Adviser a publication of LeadingAge New York | Spring 2017
(Continued)