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Effects of Cognitive Impairment on the Reliability of Geriatric Assessments in Nursing Homes
Author(s) -
Phillips Charles D.,
Chu Catharine W.,
Morris John N.,
Hawes Catherine
Publication year - 1993
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1993.tb02047.x
Subject(s) - minimum data set , medicine , inter rater reliability , cognition , gerontology , reliability (semiconductor) , medicaid , activities of daily living , dementia , nursing homes , family medicine , nursing , health care , psychiatry , rating scale , psychology , developmental psychology , power (physics) , physics , disease , pathology , quantum mechanics , economics , economic growth
Objective To explore the relationship between an elderly subject's cognitive status and the reliability of multidimensional assessment data. Design Survey, with cognitive status as the independent variable and interrater reliability as dependent variable. Setting Medicare/Medicaid‐certified nursing homes. Participants 147 residents age 65 or older. Measurements Dual assessments of elderly nursing home residents were performed by nurse assessors using the Health Care Financing Administration's new Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS). Assessments were classified on the basis of residents' cognitive status, and levels of disagreement between assessors were analyzed. Main Results Overall assessment reliability, agreement concerning a resident's activities of daily living status, and the reliability of estimates of his or her communication skills and sensory abilities were significantly affected by a resident's cognitive status. The presence of cognitive impairment made these measurements less reliable—especially those related to communication skills, vision, and hearing. Conclusions Assessments of residents suffering from cognitive impairment were significantly less reliable than assessments of cognitively intact residents. However, these differences in reliability were not uniform across all assessment domains. When treating the cognitively impaired elderly, clinicians must exercise caution in their reliance on standardized measurements that may be less reliable for this population.