Dementia screening with self-med and post fall assessments

  1. 0
    I work in an assisted living facility and I am considering using dementia screening tools such as the MoCA along with self-med assessments and post fall assessments. My thought is to discover any possible issues with self-medication safety and possible links to falls or history of falls. Does anyone have any thoughts on this? Ethical? Legal? I am in Washington state.

    Thanks,
    Diane
  2. 1,946 Visits
    Find Similar Topics
  3. 10 Comments so far...

  4. 0
    Doesn't your facility dictate what tools to use?
  5. 0
    Quote from tyvin
    Doesn't your facility dictate what tools to use?
    The only tool they have is one that is subjective. I am looking to use objective tools such as the MoCA or Clock Drawing Test (CDT).
  6. 1
    You talk about several different specific areas you want to evaluate. Your title suggest you want to test for dementia. A full eval from a neuropsychologist is the persons best bet. If you start to test people using an incomplete evaluation it could cause concerns, plus you need to be specifically trained for it.

    The general overall tool that most docs use is the MMSE. You talk about the clock test but that is given with a battery of other test as a progression that is then evaluated by someone who is as I said "trained" at it.

    I know some nurses who go around and give small tests to people like the clock or the naming animals in 60 seconds but if you haven't been formally trained you really have no idea what the results could mean in that particular persons case and could cause some real harm.

    IF you suspect someone has dementia the best thing is to have them professionally evaluated.
    VivaLasViejas likes this.
  7. 1
    When I was running an ALF, we had to assess everyone before admit. We had an assessment tool that included these things you asked about, including the clock test. The answers had scores to go along with them. If they didn't score high enough, we would refer them to their Dr. for possible nursing home admission. As far as the meds, if they chose to self administer, they had to show us that they knew what the meds were, what they were for, side effects to watch for, method of admin, etc. If they didn't do it correctly they were not able to self administer in our facility. We also had to assess self admin monthly. This was state regulation. Maybe check with your department of aging to see what the laws are.
    VivaLasViejas likes this.
  8. 0
    Quote from tyvin
    You talk about several different specific areas you want to evaluate. Your title suggest you want to test for dementia. A full eval from a neuropsychologist is the persons best bet. If you start to test people using an incomplete evaluation it could cause concerns, plus you need to be specifically trained for it.

    The general overall tool that most docs use is the MMSE. You talk about the clock test but that is given with a battery of other test as a progression that is then evaluated by someone who is as I said "trained" at it.

    IF you suspect someone has dementia the best thing is to have them professionally evaluated.
    Thank you so much for your input.

    A large majority of our residents have some level of cognitive decline. Maybe I should have said cognitive level screening instead of dementia screening. I have used the MoCA test before many times for LTC insurance assessments. It has the CDT has part of it.

    I am just trying to decide if it would be beneficial to track a residents level of cognition because many are self-med and maybe they should not be. Besides an interview we really don't do cognitive assessments when the resident first moves in. I am not looking to diagnose or "find" dementia among our residents. If a resident showed significant decline from one assessment to the next then I would have rationale to take appropriate steps regarding self-medication and yes I would have suspicion to recommend professional evaluation if appropriate.
  9. 0
    Quote from handyrn
    When I was running an ALF, we had to assess everyone before admit. We had an assessment tool that included these things you asked about, including the clock test. The answers had scores to go along with them. If they didn't score high enough, we would refer them to their Dr. for possible nursing home admission. As far as the meds, if they chose to self administer, they had to show us that they knew what the meds were, what they were for, side effects to watch for, method of admin, etc. If they didn't do it correctly they were not able to self administer in our facility. We also had to assess self admin monthly. This was state regulation. Maybe check with your department of aging to see what the laws are.
    What state was your ALF in? My facility has been self-med assessing quarterly. I have only been their 6 weeks so I am new to all the laws. I will check with our Department of Health and Social Services (I think it is). Not sure if we have a Dept. of Aging. Thanks!
  10. 0
    I am in Oregon, and the self-med assessments are done quarterly, as well as when there is a change of condition or a hospital/rehab stay. I'll also do one PRN if someone starts falling or shows other signs that things are not going well.....sometimes I pick up on some interesting things that way.
  11. 0
    Here's a link I found with several tools.

    http://www.dementia-assessment.com.au/cognitive/

    I earlier suggested the MMSE but it appears that it can be culturally and educationally challenging. I've read that many are using the RUDSA in place of the MMSE. I still like the MMSE though they say people can memorize it ... anyway you could also adjust the tools. Hope this helps.
  12. 0
    Thank you!


Top