Cognitive impairment and the quality of care in long-term care institutions

This study sought to determine whether cognitively impaired elderly in long-term care institutions receive a lower quality of care than do the non-impaired. The quality of care for each of 136 elderly in nine units for independent, frail and nursing residents was examined through the tracer method. On the basis of the MSQ test and an assessment by the ward nurse, a composite scale for measuring cognitive impairment was developed. Sixty-one percent of the elderly were found to suffer moderate to severe cognitive impairment. The cognitively impaired patients were found to receive poorer nursing care and staff were unaware of the existence of a greater proportion of their medical problems, compared with the non-impaired. The findings suggest that the lower quality care provided to the cognitively impaired is related to their greater behavioral and social problems such as aggressiveness and apathy. Staff members are apparently less inclined to have contact with patients displaying such problems. Changes of referral policies and training programs for institutional staff on the care of the cognitively impaired elderly are necessary in order to improve care for this group.