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J R Soc Med. 1995 April; 88(4): 196–198.
PMCID: PMC1295162

Recognition of cognitive impairment by day and night nursing staff among acute geriatric patients.

Abstract

The recognition of cognitive impairment by day and night nursing staff was studied in an acute geriatric unit. Seventy-six patients were randomly selected from a prospective sample of admissions. DSM-III-R diagnoses were established on all patients. Day and night staff were interviewed about each patient's clinical condition and asked to state whether or not they thought they were cognitively impaired or confused. Day staff were reasonably good at differentiating cognitively unimpaired from those with dementia and or delirium [kappa = 0.62, 95% confidence interval (CI) = 0.46-0.78]. All patients thought by day staff to be cognitively impaired were found to be so, although day staff did fail to identify some patients with cognitive impairment. Night staff performed less well (kappa = 0.37, 95% CI 0.18-0.57) and identified cognitively normal patients as being cognitively impaired, as well as failing to identify patients who were cognitively impaired. Night nursing interviews were not thought to have contributed to the management of any patient. The usefulness of night-time nursing interviews for research and general inpatient management purposes is questioned and the importance of daytime nursing interviews emphasized.

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Selected References

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  • Warshaw GA, Moore JT, Friedman SW, Currie CT, Kennie DC, Kane WJ, Mears PA. Functional disability in the hospitalized elderly. JAMA. 1982 Aug 20;248(7):847–850. [PubMed]
  • Gillick MR, Serrell NA, Gillick LS. Adverse consequences of hospitalization in the elderly. Soc Sci Med. 1982;16(10):1033–1038. [PubMed]
  • Bergmann K, Eastham EJ. Psychogeriatric ascertainment and assessment for treatment in an acute medical ward setting. Age Ageing. 1974 Aug;3(3):174–188. [PubMed]
  • Hodkinson HM. Mental impairment in the elderly. J R Coll Physicians Lond. 1973 Jul;7(4):305–317. [PubMed]
  • Liptzin B, Levkoff SE. An empirical study of delirium subtypes. Br J Psychiatry. 1992 Dec;161:843–845. [PubMed]
  • Rabins PV, Folstein MF. Delirium and dementia: diagnostic criteria and fatality rates. Br J Psychiatry. 1982 Feb;140:149–153. [PubMed]
  • Lipowski ZJ. Delirium (acute confusional states). JAMA. 1987 Oct 2;258(13):1789–1792. [PubMed]
  • BEDFORD PD. General medical aspects of confusional states in elderly people. Br Med J. 1959 Aug 15;2(5145):185–188. [PMC free article] [PubMed]
  • Thomas RI, Cameron DJ, Fahs MC. A prospective study of delirium and prolonged hospital stay. Exploratory study. Arch Gen Psychiatry. 1988 Oct;45(10):937–940. [PubMed]
  • Francis J, Kapoor WN. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc. 1992 Jun;40(6):601–606. [PubMed]
  • Nelson A, Fogel BS, Faust D. Bedside cognitive screening instruments. A critical assessment. J Nerv Ment Dis. 1986 Feb;174(2):73–83. [PubMed]
  • Levkoff S, Liptzin B, Cleary P, Reilly CH, Evans D. Review of research instruments and techniques used to detect delirium. Int Psychogeriatr. 1991 Winter;3(2):253–271. [PubMed]
  • Millar HR. Psychiatric morbidity in elderly surgical patients. Br J Psychiatry. 1981 Jan;138:17–20. [PubMed]
  • Lipowski ZJ. Transient cognitive disorders (delirium, acute confusional states) in the elderly. Am J Psychiatry. 1983 Nov;140(11):1426–1436. [PubMed]
  • Evans LK. Sundown syndrome in institutionalized elderly. J Am Geriatr Soc. 1987 Feb;35(2):101–108. [PubMed]
  • Francis J. Delusions, delirium, and cognitive impairment: the challenge of clinical heterogeneity. J Am Geriatr Soc. 1992 Aug;40(8):848–849. [PubMed]
  • Williams MA, Ward SE, Campbell EB. Confusion: testing versus observation. J Gerontol Nurs. 1988 Jan;14(1):25–30. [PubMed]
  • Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. [PubMed]

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