Cognitive screening in geriatric rehabilitation.

Objective: To aid rehabilitation psychologists' selection of brief measures of cognition for use in geriatric rehabilitation. Design: Literature review of neuropsychological screening measures that have been used and researched in geriatric rehabilitation, along with some newer instruments that have potential efficacy. Conclusions: All of the cognitive screening measures reviewed have varying degrees of strength and weakness in a geriatric rehabilitation setting. Thus, choosing the appropriate instrument often hinges on both pragmatic (e.g., administration time, nature of the referral, availability of population-specific norms) and psychometric concerns. Although tests are valuable tools, the lack of available research for many tests must be corrected before the practicing clinician can feel comfortable using them as integral aspects of geriatric rehabilitation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Risk Assessment as an Integral Aspect of Capacity Evaluations.

Objective: To highlight the need for rehabilitation psychologists' evaluation of potential risks when examining an individual's decision-making capacity (DMC). Design: A literature review of research regarding decision making, predictive accuracy, and rehabilitation outcomes. Conclusions: The perceived level of risk or potential harm entailed in a decision determines the "sliding scale" for DMC. There is much less research on risk assessment than on the cognitive components needed for DMC, meaning that clinicians usually have to rely on clinical judgment. Clinical judgment is often inaccurate in terms of identifying factors that could increase the risk for harm and is susceptible to errors when predicting future risk. It is therefore argued that the process of assessing an individual's DMC must be matched by an equally rigorous analysis of clinicians' ability to quantify situational risk. Only when these 2 components are properly considered can an adequate standard for DMC be established. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of the neurobehavioral cognitive status examination with geriatric rehabilitation patients.

Objective: To provide normative data for 3 commonly encountered rehabilitation diagnostic groups and examine demographic influences on the Neurobehavioral Cognitive Status Examination (NCSE, now called Cognistat). Design: Normative data are presented along with correlational associations to demographic variables. Analysis of variance was used to examine test scores between the 3 diagnostic groups. Particoants: Eighty-six urban geriatric rehabilitation patients (34 recent total joint replacements, 22 with general medical conditions, and 30 with diagnosed neurological disorders). Results: Scores on many of the NCSE scales are associated with level of education. Five subtests evidenced performance differences between the joint replacement and neurologic groups. Conclusions: The NCSE has utility in detecting cognitive dysfunction with geriatric rehabilitation patients, although caution is suggested in NCSE interpretation in a lesser educated, older population because of educational effects on test performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical decision making in the prediction of falls.

Objective: Examine rehabilitation professionals' capacity to identify risk factors for patient falls. Design: Survey study. Setting: Three academic medical center rehabilitation departments. Participants: Fifty-six rehabilitation specialists representing disciplines typically involved in patient care, including physiatry and occupational, physical, recreation, and speech therapy. Measures: A 2-part, self-report questionnaire with spontaneous and cued rank-order listing of factors related to fall risk. Results: Clinicians did not consider advanced age and history of falling when spontaneously delineating risks for falls. The importance of fall history, but not of advanced age, was recognized through cueing. Conclusions: Clinicians appear aware of strong predictors of fall risk but require cueing to consistently use them. Cueing increased hypothetical predictive accuracy, although clinicians still downplayed some of the most salient predictive factors. Staff education regarding validated fall risk factors and potential errors in clinical decision making can improve patient care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)