Memory and cognition problems affect recovery in rehabilitation facilities

Cognitive impairment is when you have difficulties with memory and your ability to think and make decisions. Some studies have examined how cognitive impairment can affect recovery for nursing home residents. But recently, the Centers for Medicare and Medicaid Services (CMS) added new ways to measure patients' abilities to perform their daily routines in nursing facilities and other after-care settings.

So far, studies have not examined how skilled nursing care residents who have cognitive difficulties perform on the new self-care and mobility measurements. Researchers designed a new study to fill that knowledge gap. Using new measurements, it examines changes in residents' self-care and their ability to get around. The study was published in the Journal of the American Geriatrics Society.

Participants in the study were Medicare Part A beneficiaries who stayed in a skilled care facility between January 1 and June 30, 2017, but who had not stayed in one in 2016. The study included 246,395 skilled nursing home stays.

The researchers used these measures of self-care and mobility:

• Eating
• Oral hygiene
• Ability to use/get to the toilet
• Moving from a sitting to lying position
• Moving from a lying to sitting position
• Moving from a sitting to standing position
• Ability to move from chair or bed to chair

These items were scored by health professionals in the nursing homes when residents were admitted and discharged. They used a scale to measure residents' mobility. The scale ranged from 1 (Dependent: Helper does all of the effort) to 6 (Independent: Resident completes the activity by themselves with no assistance from a helper).

The average length of stay in the nursing facilities was 24 days and most residents were between 65 and 84 years old. Sixty-eight percent of residents had no cognitive impairment when they were admitted to the nursing facility, 18.3 percent had mild impairment, 11.8 percent had moderate impairment, and 1.7 percent had severe impairment.

About 20 percent of the participants had an active diagnosis of a fracture, 30 percent had diabetes, and 27 percent had psychiatric mood disorders. Almost half the participants experienced some urinary incontinence and half had fallen in the last six months.

The researchers learned that the participants' cognitive status significantly affected their scores. Residents with severe cognitive impairment scored lower than those who were cognitively intact. When they were discharged, residents with severe cognitive impairment scored about one point higher than when they were admitted. This is compared to residents who had no cognitive problems, who scored about two points higher when they were discharged.

Nearly all of the residents who had no cognitive difficulties at admission improved their ability to get around. In contrast, 87 percent of those with severe cognitive impairments improved.

The researchers concluded that residents with more severe cognitive problems didn't improve as much in terms of self-care and mobility as did residents who were cognitively intact when they were admitted. The researchers thus suggested that residents with cognitive impairment may need additional support and more intense rehabilitation to make the same gains as residents who are cognitively intact.