Identifying residents at greater risk for cognitive decline by Minimum Data Set in long-term care settings

Background/Purpose: Dementia is associated with an individual's dependency and disability, and poses a great care burden to families and societies. Neuroimaging tools and screening questionnaires are important for early diagnosis. However, factors predicting cognitive decline still remain unknown among the elder population, especially in long-term care settings. Methods: A total of 1279 residents of veteran homes in Taiwan were enrolled in this prospective study. Demographic data and items retrieved from the Minimum Data Set, including resident assessment protocols (RAPs), Minimum Data Set Cognitive Scale scores, and Resource Utilization Group-III Activities of Daily Living (RUG-III ADL) Scale scores, were analyzed. The participants were also screened using the Mini-Mental Status Examination questionnaire and assessed by the 15-item Geriatric Depression Scale. Results: All participants were male (mean age: 83.2 ± 5.1 years), and 9.9% developed significant cognitive decline. Obvious discrepancy in the prevalence of dementia and depression was noted between the results of screening tests and physicians' diagnosis. Participants with cancer, chronic lung disease, and poor RUG-III ADL status were at greater risk of hospitalization or death. By contrast, those with poor RUG-III ADL status, positive RAP triggers for cognitive loss/dementia, and higher sum of RAP triggers were at higher risk of developing cognitive decline. Conclusion: The diagnosis of dementia and depression remained lower than expected among the elderly population. As presented here, poor physical function, presence of RAP triggers for cognitive loss/dementia, and a higher sum of RAP triggers were strong predictors for cognitive decline.