MDS 3.0 Cognitive Patterns in Nursing Home Residents

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The level of cognitive ability among nursing home residents helps determine a proper care plan and therefore contributes to their quality of care and quality of life. In the past, understanding cognitive patterns were done by simply observing residents and making notes. Much has changed under MDS 3.0 (Minimum Data Set) Cognitive Patterns in Nursing Home Residents.

Nursing facilities must determine whether the Brief Interview for Mental Status (BIMS) can be conducted with residents by a social worker. This provides a much better indicator of a resident’s cognitive ability.

Without an attempted cognitive interview, a resident might be mislabeled based on his or her appearance or assumed diagnosis. The BIMS should be conducted if the resident can respond verbally or by writing out the answers.

Why This Is Important

A structured cognitive interview is important:

  • It is more accurate and reliable than observation alone.
  • Structured interviews provide insight into the resident’s current condition.
  • Structured cognitive interviews assist in identifying support services needed.
  • The structured cognitive interview is helpful for identifying possible delirium behaviors.

Quality of Life for Residents

When all is said and done, this is about the quality of life for residents. Observation alone can be misleading. Conversely, some residents may appear to be more cognitively intact than they actually are.

If you do not diagnose cognitive impairment correctly you run the risk of the resident missing appropriate communication, worthwhile activities, and therapies that would otherwise be offered.

Determining If You Can Conduct an Interview

Facilities need to coordinate assessments of cognitive function with occupational and speech therapy team members when a patient is identified. Most residents should be able to attempt the BIMS. There are exceptions.

  • If the resident is rarely/never understood verbally or in writing.
  • If the resident needs or wants an interpreter.

The interview should not be attempted if the resident is rarely/never understood or an interpreter is needed but not available.

Preparing for the Interview

  • Conduct the interview in a private setting.
  • Be sure the resident can hear you.
  • Residents with hearing impairment should be tested using their usual communication devices/techniques.
  • Minimize background noise.
  • Sit so that the resident can see your face.
  • Minimize glare.
  • Introduce yourself.

Brief Interview for Mental Status

The following constitute the BIMS interview.

  • Repetition of Three Words
    • “I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are sock, blue, and bed.”
    • This is important because the inability to repeat three words on the first attempt may indicate: a hearing impairment, a language barrier, or inattention that may be a sign of delirium.
    • A cue can assist in learning. Staff can use cues when assisting residents with learning and recall in therapy, and in daily and restorative activities.
  • Orientation to Year, Month, and Day
    • “Please tell me what year it is right now.”
    • “What month are we in right now?”
    • “What day of the week is today?”
    • This is important because a lack of temporal orientation may lead to decreased communication or participation in activities.
    • If staff know that a resident has a problem with orientation, they can provide reorientation aids and verbal reminders that may reduce anxiety.
    • Recall“Let’s go back to an earlier question. What were those three words that I asked you to repeat?”
    • Many persons with cognitive impairment can be helped to recall if provided cues. Providing memory cues can help maximize individual function and decrease frustration.
    • Care plans should maximize use of cueing for residents who respond to recall cues. This will enhance independence.

Assessment of a resident’s mental state provides a direct understanding of resident function.

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