Introduction to Screening/Assessment Tools for Mood & Cognition Pam Hamilton Psychogeriatric Resource Consultant for KFLA Susanne Murphy Resource Consultant, BCICC-LTC & GiiC
Screening/Assessment for Delirium, i Dementia, Depression Using standardized screening/assessment tools Using informal information i gathering through; h observation, conversation (patient, family, others) Application of the learning using Build-A-Case Reflection on outstanding learning needs and key take away messages
Standardized d Assessment/Screening e ee Tools USEFUL to: improve communications assist with characterizing the population document change problem-solving plan interventions teach clinical assessments augment findings from a holistic assessment 3
Avoid Assumptions! Think Atypical If all you have is a hammer, everything begins to look like a nail.
Delirium Suspect a Delirium if sudden changes are reported or observed in the following key areas: Function/capabilities Communication Attention Thinking/memory Levels of consciousness Remember: Avoid assumptions! Think Atypical Tool: Confusion Assessment Method (CAM)
Dementia Cognitive Screening/Assessment Avoid assumptions that; presenting problems due to progression of an existing dementia primary problem is caregiver stress related to an existing dementia primary problem is related to a mental health issue(s); and as a result cognitive impairment is not screened Remember to ask What has changed? Think Atypical!
Cognitive Screening/Assessment Tools: Mini i Cog Plus Clock Drawing
Administration Mini-cog Pus (Adapted Mini-Cog) 1. Three-item recall: Ask the individual to remember the following three words to be recalled later: House Tree Car 2. Clock drawing test: Draw a clock. Put in all the numbers and set the time to 10 after 11. The CDT serves as the distractor for the three-item recall. 3. Three-item recall: 4. Animal Naming: Ask the individual to name as many animals as they can within one minute. Record the total number of animals. Interpretation Test Negative Screen Positive Screen Odds Ratio 3-item recall 2 or 3 words recalled 0 or 1 word recalled 3.1 times Animal 15 animals < 15 animals- 20.2 naming positive screen times 10-14 animals suggests mild cognitive impairment (MCI) <10 animals suggests dementia Clock Drawing 24 times Normal clock or only minor irregularities in number placement with hands on the correct position Abnormal clock: handand/or number placement
Animal Naming:
Put in the numbers so it looks like a clock
Put in the numbers so it looks like a clock
Put in the numbers so it looks like a clock
Add arms so that the clock indicates the time ten minutes after eleven
Add arms so that the clock indicates the time ten minutes after eleven
Depression Atypical presentation in the older person: Irritability Insomnia Importuning Persistent somatic complaints Anxiety Memory/concentration/attention problems Psychomotor changes Ruminations guilt Remember to ask What has changed? Avoid Assumptions
Depression Screening/Assessment Tools: SIGECAPS 5 - Item Geriatric Depression Scale (GDS)
Sleep Interest Guilt Depression Screening/Assessment Energy Concentration Appetite Psychomotor Changes Suicide SIG E CAPS
5-Item Geriatric Depression Scale [GDS] 5-Item Geriatric Depression Scale [GDS]: 1. Are you basically satisfied with your life? 2. Do you often get bored? 3. Do you often feel helpless? 4. Do you prefer to stay at home rather than going out and doing new things? No No No No Yes Yes Yes Yes 5. Do you feel pretty worthless the way you are now? Each bolded answer scores as 1 point. If score is 2 or greater, further evaluation is recommended. Score No Yes
Informal Screening and Assessment Informal screening informs your current assessment processes and becomes evident through what you see and hear through the most basic of activities The observations and conversations happen real time and provide invaluable information to guide assessment and management for the whole team
Gaining Insight Through Direct Observation and Interaction It s very busy in your practice environment so to save time you: Help your patient up to the bathroom You set up the meal tray opening all containers and then move on to the next task You help someone assist or have another team member assist with basic personal care When asking questions or interviewing you automatically turn to the caregiver first What information have you just missed.
Activities That Inform Going to the bathroom Taking Medications Basic ADL s such as eating, brushing teeth, combing hair, getting dressed or washing hands and face Conversation about IADL s is the report consistent with what you see?
What to consider For everything you observe consider: Cognition Mood / behaviour Physical function Sensory function Past medical history Common co-morbidities and atypical presentation
Then ask is there a change what has changed?
Involving the Inter-professional Team Who are the members of the team? What are the roles of the team members? What other services are available where you practice?
Case Scenario 1 Meet Frank Admission a week ago following a fall at home # L hip with ORIF Slow recovery and now having some difficulties with cognition
Case Scenario 2 Meet Freida She s spent about 48 hours in the ER and was admitted to IMU related to difficulties managing at home Every time her meal tray comes she doesn t eat a bite, she rings the call bell around the clock and is getting out of bed at night wandering the halls
Build-A-Case Think of a typical individual in your practice setting Tell the story of this person What do you know about them (medical history, presenting condition(s), functional status, identified problems, social circumstances, etc ) How and why are you involved? What are the things you want to and need to know about them? What are the key interventions and services? What resources, skills and tools do you have? What are the resources available within your practice community Are there any gaps?
Learning Needs Reflection Your Needs Addressed Has the identified learning need been addressed through this session? If yes, identify tools, resources and/or ideas reinforced through this session If no, tell us What is one small but specific thing that needs to happen to meet this learning need? Who or what is involved in meeting this learning need? Are you able to identify resources within the group that could be mobilized to meet this need?
Thank You