Point-of-care screening to identify cognitive impairment in older adults

Abstract

Objective: To explore associations between results of a rapid screening tool for cognitive impairment and individual patient characteristics in a sample of patients receiving outpatient anticoagulation therapy who were not previously diagnosed with a dementia.

Design: Descriptive, nonexperimental, cross-sectional study.

Setting: Pharmacist-managed anticoagulation clinic in Spokane, WA, from June 2006 to March 2007.

Participants: 300 community-dwelling patients aged 60 years or older who had at least 6 months of outpatient anticoagulation therapy services.

Intervention: Following informed consent, demographic, medical history, medication history, anticoagulation therapy, and cognitive screening data were recorded from participant medical records, and a participant interview was performed using a standardized questionnaire and data collection form.

Main outcome measures: Cognitive screening status (suggests cognitive impairment versus suggests dementia less likely) was used as an independent variable by which to compare patient demographics, medical history, medication history, and percent of out-of-range International Normalized Ratio (INR) visits.

Results: 55 of 300 participants (18.3%) with no previous diagnosis of a cognitive impairment were classified as "suggests cognitive impairment" based on the screening test. Presence or absence of cognitive impairment differed in those needing assistance with taking medications but was not associated with other sample characteristics, including percentage of visits with out-of-range INR value, gender, in-home care needs, age, and number of medical conditions.

Conclusion: Screening at a convenient health care access point may lead to increased identification of community-dwelling elderly patients with unrecognized and undiagnosed cognitive impairment. Pharmacists are particularly well suited to conduct this screening because of the extended and frequent contact they have with patients in settings such as anticoagulation therapy clinics.