Cognitive screening tests as experienced by older hospitalised patients: a qualitative study

Older people admitted to geriatric wards in hospitals are often screened for cognitive impairments. The validity and diagnostic concerns of cognitive screening tests have been subjected to comprehensive research. However, the qualitative knowledge available on how older patients themselves experience these screening tests is limited. The aim of this study is to explore the cognitive screening test experience from the older patients' perspective. Drawing on fieldwork, qualitative interviews were performed with 18 older patients who had completed cognitive screening tests while hospitalised. Data from the interviews were analysed according to a phenomenological approach. The results were supported by Nordenfelt's theory on dignity of identity, which underscores that dignity is related to integrity, autonomy, life history and relationships. The findings suggest that the occupational therapists' initial presentation of the screening test is not fully understood by the older patient, leaving the patient to interpret the experience in light of the questions answered and the tasks solved in the screening. The significance of the screening may, thus, not be understood by the patient until it is over. The patients found the screening strenuous, mostly due to a felt pressure to perform. Depending on how patients assessed their own performance, feelings ranging from shame and irritation to pride and relief were stirred up. Voicing these experiences proved difficult and, for some, was even an emotional challenge. Our material reflects the impact the screening had on the older patients' dignity. Furthermore, the threat the screening experience poses to individuals' dignity and, more specifically, to their self-respect should be monitored and dealt with by healthcare professionals.