Journal of Gerontological Nursing

Cognitively Impaired Elders USING RESEARCH FINDINGS TO IMPROVE NURSING CARE

Carol Danner, RN, MNSc; Cornelia Beck, PhD, RN; Patricia Heacock, PhD, RN; Tomye Modlin, MNSc, RN

Abstract

INTRODUCTION

The growing number of elders, many with cognitive and functional impairment, increasingly concerns health professionals. Preservation of functional ability among this group, especially the ability to perform activities of daily living (ADLs), presents a major challenge. Ninetyone percent of elderly nursing home residents require assistance in performing ADLs (Kane, 1983). The degree of cognitive impairment directly affects functional ability. Cognitively impaired elderly are often placed in long-term care facilities where they may become more dysfunctional and dependent, thus diminishing their quality of life (Geiger, 1 988; Yazdanfar, 1990).

The extent to which dependency in elders is related to actual physical and mental impairment remains undetermined. Frequently, professionals view ADL disabilities of cognitively impaired elders as inevitable and believe they can do little beyond providing a minimal standard of custodial care. Also, professionals often view persons with dementing conditions such as Alzheimer's disease as a homogenous group with identical cognitive losses. Though cognitive losses in Alzheimer's disease may be similar, each person loses different abilities at different times and each responds differently to interventions. Current studies suggest that professionals can maximize functional ability by assessing specific cognitive abilities and using this information to design specific interventions to facilitate and maintain functional ability (Beck, 1988; Doyle, 1986). Each cognitively impaired elder requires an individual assessment to tailor interventions to the specific abilities each possesses.

Little information specifically addresses preservation of functional ability in cognitively impaired elders. Instead, research has focused on functional ability as related to the components of language, motor movement, and reasoning/judgment capabilities of cognitively impaired elders. These components appear to have a significant impact on the ability to perform ADLs. Clinicians can use this information to develop individual strategies to help cognitively impaired elders preserve and enhance their functional ability.

A review of recent studies assessing communication, motor skills, memory, and procedural learning in cognitively impaired patients is presented in the Table. The purpose of this table is to facilitate use of recent research in order to improve or maintain functional ability in patients with cognitive impairment. Few studies included information on norming of the assessment instruments with the elderly, the subject's stage of AD, percentage of co-morbidity, race, ethnicity, or culture of the sample.

Table

Studies of cognitive abilities (Becker, 1987; Knopman, 1987; Brandt, 1988; Granholm, 1988) suggest that cognitively impaired persons have poor initial encoding of Stimuli, accounting for impaired recall among Alzheimer's victims, but that they can continue to respond to verbal and physical cues. Motor movement studies (Baum, 1988; Dick, 1988) reflect the cognitively impaired's ability to code meaningful aspects of motor movement.

Development of assessment tools that evaluate the domains of cognitive functioning is important to design interventions specific to the needs of the cognitively impaired elderly. Research is needed to ascertain techniques that assist in the maintenance and enhancement of functional ability with this population.

TABLE 1

Communication: Language and Writing Ability Studies

TABLE 1

Communication: Language and Writing Ability Studies

TABLE 2

Motor Skills Studies

TABLE 3

Memory Studies

TABLE 4

Procedural Learning Studies…

INTRODUCTION

The growing number of elders, many with cognitive and functional impairment, increasingly concerns health professionals. Preservation of functional ability among this group, especially the ability to perform activities of daily living (ADLs), presents a major challenge. Ninetyone percent of elderly nursing home residents require assistance in performing ADLs (Kane, 1983). The degree of cognitive impairment directly affects functional ability. Cognitively impaired elderly are often placed in long-term care facilities where they may become more dysfunctional and dependent, thus diminishing their quality of life (Geiger, 1 988; Yazdanfar, 1990).

The extent to which dependency in elders is related to actual physical and mental impairment remains undetermined. Frequently, professionals view ADL disabilities of cognitively impaired elders as inevitable and believe they can do little beyond providing a minimal standard of custodial care. Also, professionals often view persons with dementing conditions such as Alzheimer's disease as a homogenous group with identical cognitive losses. Though cognitive losses in Alzheimer's disease may be similar, each person loses different abilities at different times and each responds differently to interventions. Current studies suggest that professionals can maximize functional ability by assessing specific cognitive abilities and using this information to design specific interventions to facilitate and maintain functional ability (Beck, 1988; Doyle, 1986). Each cognitively impaired elder requires an individual assessment to tailor interventions to the specific abilities each possesses.

Little information specifically addresses preservation of functional ability in cognitively impaired elders. Instead, research has focused on functional ability as related to the components of language, motor movement, and reasoning/judgment capabilities of cognitively impaired elders. These components appear to have a significant impact on the ability to perform ADLs. Clinicians can use this information to develop individual strategies to help cognitively impaired elders preserve and enhance their functional ability.

A review of recent studies assessing communication, motor skills, memory, and procedural learning in cognitively impaired patients is presented in the Table. The purpose of this table is to facilitate use of recent research in order to improve or maintain functional ability in patients with cognitive impairment. Few studies included information on norming of the assessment instruments with the elderly, the subject's stage of AD, percentage of co-morbidity, race, ethnicity, or culture of the sample.

Table

TABLE 1Communication: Language and Writing Ability Studies

TABLE 1

Communication: Language and Writing Ability Studies

Table

TABLE 1Communication: Language and Writing Ability Studies

TABLE 1

Communication: Language and Writing Ability Studies

CONCLUSIONS

This review summarizes recent research on four components of cognition among the cognitively impaired elderly: communication, language and writing ability, motor skills, memory, and procedural learning. Assessing cognitive functioning is necessary to design appropriate interventions. Interventions are needed to maintain or improve the ability to perform ADLs.

Table

TABLE 2Motor Skills Studies

TABLE 2

Motor Skills Studies

Table

TABLE 3Memory Studies

TABLE 3

Memory Studies

Table

TABLE 4Procedural Learning Studies

TABLE 4

Procedural Learning Studies

Studies of cognitive abilities (Becker, 1987; Knopman, 1987; Brandt, 1988; Granholm, 1988) suggest that cognitively impaired persons have poor initial encoding of Stimuli, accounting for impaired recall among Alzheimer's victims, but that they can continue to respond to verbal and physical cues. Motor movement studies (Baum, 1988; Dick, 1988) reflect the cognitively impaired's ability to code meaningful aspects of motor movement.

Development of assessment tools that evaluate the domains of cognitive functioning is important to design interventions specific to the needs of the cognitively impaired elderly. Research is needed to ascertain techniques that assist in the maintenance and enhancement of functional ability with this population.

REFERENCES

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TABLE 1

Communication: Language and Writing Ability Studies

TABLE 1

Communication: Language and Writing Ability Studies

TABLE 2

Motor Skills Studies

TABLE 3

Memory Studies

TABLE 4

Procedural Learning Studies

10.3928/0098-9134-19930401-04

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