Memory and cognition problems affect recovery in rehabilitation facilities

December 20, 2018

After a hospital stay, many older adults will be discharged to a skilled nursing facility to recover. The goal of this type of short-term nursing care is to help patients regain their ability to function and perform their daily activities to the best of their ability so they can return home, if possible.

Cognitive impairment is when you have difficulties with memory and your ability to think and make decisions. Some studies have examined how cognitive impairment can affect recovery for nursing home residents. But recently, the Centers for Medicare and Medicaid Services (CMS) added new ways to measure patients' abilities to perform their daily routines in nursing facilities and other after-care settings.

So far, studies have not examined how skilled nursing care residents who have cognitive difficulties perform on the new self-care and mobility measurements. Researchers designed a new study to fill that knowledge gap. Using new measurements, it examines changes in residents' self-care and their ability to get around. The study was published in the Journal of the American Geriatrics Society.

Participants in the study were Medicare Part A beneficiaries who stayed in a skilled care facility between January 1 and June 30, 2017, but who had not stayed in one in 2016. The study included 246,395 skilled nursing home stays.

The researchers used these measures of self-care and mobility:

These items were scored by health professionals in the nursing homes when residents were admitted and discharged. They used a scale to measure residents' mobility. The scale ranged from 1 (Dependent: Helper does all of the effort) to 6 (Independent: Resident completes the activity by themselves with no assistance from a helper).

The average length of stay in the nursing facilities was 24 days and most residents were between 65 and 84 years old. Sixty-eight percent of residents had no cognitive impairment when they were admitted to the nursing facility, 18.3 percent had mild impairment, 11.8 percent had moderate impairment, and 1.7 percent had severe impairment.

About 20 percent of the participants had an active diagnosis of a fracture, 30 percent had diabetes, and 27 percent had psychiatric mood disorders. Almost half the participants experienced some urinary incontinence and half had fallen in the last six months.

The researchers learned that the participants' cognitive status significantly affected their scores. Residents with severe cognitive impairment scored lower than those who were cognitively intact. When they were discharged, residents with severe cognitive impairment scored about one point higher than when they were admitted. This is compared to residents who had no cognitive problems, who scored about two points higher when they were discharged.

Nearly all of the residents who had no cognitive difficulties at admission improved their ability to get around. In contrast, 87 percent of those with severe cognitive impairments improved.

The researchers concluded that residents with more severe cognitive problems didn't improve as much in terms of self-care and mobility as did residents who were cognitively intact when they were admitted. The researchers thus suggested that residents with cognitive impairment may need additional support and more intense rehabilitation to make the same gains as residents who are cognitively intact.

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This summary is from "Relationship between functional improvement and cognition in short-stay nursing home residents" It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Lacey Loomer, MSPH; Brian Downer, PhD; and Kali Thomas, PhD, MA.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

About the Journal of the American Geriatrics Society

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.

American Geriatrics Society

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