Objective: To screen for undetected cognitive impairment in homebound elders receiving home health care services.
Design: A cross-sectional study of adults 60 years of age and older receiving visiting nurse services. A pharmacist administered the Mini-Cog, a rapid screening test for cognitive impairment, during the enrollment home visit.
Setting: Participants' homes.
Participants: A consecutive sample of 100 homebound adults, 60 years of age or older with no previous diagnosis of dementia, Alzheimer's disease, or other cognitive impairment.
Main Outcome Measure: Percentage of participants scoring in the likely impaired range (screen failure) on the Mini-Cog.
Results: Seventeen percent of persons with no prior diagnosis of dementia or cognitive decline failed the Mini-Cog.
Conclusion: Rates of undetected cognitive impairment are substantial in homebound elders receiving care from a visiting nurse service. The home health setting represents an important point in the continuum of geriatric care for detection of cognitive impairment. Future work should define the types and trajectories of cognitive impairment detected in home care patients by simple screens such as the Mini-Cog and test ways to integrate this knowledge into longitudinal treatment plans across settings of care.
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