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Defining severe dementia with the Minimum Data Set.

Jenny T van der Steen·Ladislav Volicer·Debby L Gerritsen·Robin L Kruse·Miel W Ribbe·David R Mehr
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Abstract

BACKGROUND: Accurately defining severe dementia is important for care and prognosis, but is not explicitly included in the Minimum Data Set (MDS). OBJECTIVE: To define severe dementia using the MDS, we used data for nursing home residents with moderate to severe dementia. METHODS: Two cross-sectional studies enrolled 175 residents; 89 residents from one US Veterans Affairs nursing home, and 86 residents from nine Dutch nursing homes. Measurements included the Cognitive Performance Scale (CPS; range: 0-6), activities of daily living (ADL) dependency, and the Bedford Alzheimer Nursing Severity-Scale (BANS-S; range: 7-28), a staging instrument specific for severe dementia. RESULTS: Half of the residents received CPS scores of 5, and their BANS-S scores varied widely. There was fair agreement (kappa=0.36) between severe cognitive impairment as defined by the CPS (scores 5 and 6) and the BANS-S (score 17 or higher). Addition of an ADL dependency requirement to the CPS definition improved agreement (kappa=0.75). The observed patterns were similar but more obvious for US residents than for Dutch residents. CONCLUSION: Cognitively impaired residents comprise a heterogeneous group with a wide variety of function. Restriction with respect to ADL dependency allows for distinction between moderate and severe dementia. We propose the following MDS-based definition of severe dementia: a CPS score of 5 or 6 with a minimum score of at least 10 points on the MDS ADL-Short Form.

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Activities of Daily LivingAgedAged, 80 and overAlzheimer DiseaseCross-Sectional StudiesData CollectionDementiaFemaleGeriatric AssessmentHumansMaleNeuropsychological TestsNursing HomesSeverity of Illness IndexJournal ArticleResearch Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, Non-P.H.S.

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Jenny T van der Steen, Ladislav Volicer, Debby L Gerritsen, Robin L Kruse, Miel W Ribbe, David R Mehr. 2006. Defining severe dementia with the Minimum Data Set.. https://doi.org/10.1002/gps.1618

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