Memory Awareness in Nursing Home Residents

Abstract

Background: Health care providers often believe that individuals with cognitive disturbance are unaware of their deficits. The term unawareness was first used to describe hemiplegia following right hemisphere stroke but has since been applied to unawareness of any neurological or neuropsychological deficit. Clinicians usually rely on their subjective observations to evaluate the patient’s awareness of deficits, and few investigators have systematically evaluated this important clinical phenomenon. Objective: The aim of this study was to compare cognition, depression, health, and metamemory (capacity, change, locus, and strategy) in four groups of nursing home residents: the cognitively impaired (29%), depressed (18%), mixed with both cognitive impairment and depression (32%), and controls (21%). Methods: Subjects were 106 residents of six nursing homes between the ages of 79 and 87 with a mean age of 84.18 (SD = 10.01) years, and an average of six comorbid medical conditions. Cognitive function was measured with the Mini Mental State (MMSE); depression with the Geriatric Depression, and metamemory with the Metamemory in Adulthood scales. Anyone scoring <15 on the MMSE was excluded. Subjects included 31 with cognitive impairment, 19 depressed, 34 mixed, and 22 controls. Results: In this sample, 61% were cognitively impaired; however, only 12 had a diagnosis in their records indicating cognitive disturbance. Forty-three percent were depressed. The correlations between depression and capacity (r = –0.38), change (r = –0.50), and locus (r = –0.25) were significant. The controls were significantly younger than the cognitively impaired group. The controls also had higher perceived health status scores than either the cognitively impaired or the depressed group. However, the mixed group’s perceived health status scores were significantly higher than the depressed group’s scores. Conclusion: The metamemory components of capacity and change were able to differentiate the cognitively impaired from the mixed group. Information on the etiology of cognitive impairment was not available since residents’ charts in the six nursing homes provided inadequate documentation and incomplete diagnostic histories. Therefore, quantitative methods for examining memory awareness and the affective state of elderly patients is important for clinicians in order to make informed treatment decisions.

Positive Psychosocial Functioning in Later Life: Use of Meaning-Based Coping Strategies by Nursing Home Residents

“…Cognitive function was assessed using the MMSE, a brief, widely used, and easily administered 20-item test of cognitive function, including orientation, registration, language and praxis, memory recall, and attention/calculation ability. Scores range from 0-30, with scores of 23 and below typically indicative of cognitive impairment (Karuza, Katz, & Henderson, 1997;McDougall, 1998;Phillips, Chu, Morris, & Hawes, 1993). (Ware & Sherbourne, 1992).…”

Psychometric Properties of the French Version of the Multifactorial Memory Questionnaire for Adults and the Elderly

“…Kuder-Richarson's estimate of reliability for scores on the GDS was 0.78. Because research has demonstrated that mood affects not only cognitive functioning but also self-confidence, we hypothesized that scores on the MMQ would be positively correlated with scores on the GDS (Ide, McDougall, & Wykle, 1999;McDougall, 1998). Fort's (2000) Memory Aging Questionnaire (MAQ) was administered to assess how participants conceived of memory changes with advancing age.…”

Memory Self-Efficacy and Memory Performance in Older Males

“…In one study healthy older males had lower scores on selfreported memory function than females (McDougall, 1998a). In another study of nursing home residents, McDougall (1998b) found scores on the capacity and change metamemory scales were significantly lower in the group with mixed depression and cognitive impairment when compared to a group with cognitive impairment and no depression. This phenomenon of compromised thinking, anxiety, and decreased confidence in memory has been described as mental frailty by McDougall and Balyer (1998) and sense of control by Lachman, Steinberg, and Trotter (1987) and Lachman and Leff (1989).…”