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    Careplan

    Cognitive Impairment, Adult

    Jan.13.2021

    Cognitive Impairment (Adult Inpatient)

    Clinical Description

    • Care of the hospitalized patient experiencing impairment related to cognitive skills that include attention, memory, orientation, judgment, reasoning, problem-solving and executive functioning with reasonable potential for improvement.

    Key Information

    • Language and culture may affect results of standardized assessment tools. Choose tools appropriate for the patient to provide the most accurate cognitive assessment.
    • Hospitalization and illness stress cognitive abilities and exacerbate dysfunctional behaviors.
    • It is important to identify and address safety concerns related to cognitive dysfunction, such as medication adherence, decision-making capacity, safety with functional mobility tasks and wandering.

    Clinical Goals

    By transition of care

    A. The patient will achieve the following goals:

    • Optimal Cognitive Function

    B. Patient, family or significant other will teach back or demonstrate education topics and points:
    • Education: Overview
    • Education: Self-Management
    • Education: When to Seek Medical Attention

    Correlate Health Status

    • Correlate health status to:

      • history, comorbidity
      • age, developmental level
      • sex, gender identity
      • baseline assessment data
      • physiologic status
      • response to medication and interventions
      • psychosocial status, social determinants of health
      • barriers to accessing care and services
      • health literacy
      • cultural and spiritual preferences
      • safety risks
      • family interaction
      • plan for transition of care

    Cognitive Impairment

    Signs/Symptoms/Presentation

    • aggression
    • agitation
    • apathy
    • concentration poor
    • difficulty learning or following instructions
    • disorientation
    • distractibility
    • forgetfulness
    • impulsive behavior
    • irritability
    • judgment impaired
    • memory impaired
    • problem-solving ability altered
    • reasoning ability impaired
    • word-finding difficulty

    Problem Intervention

    Optimize Cognitive Function

    • Assess cognitive function using a standardized tool to establish baseline and identify areas of deficit.
    • Establish rapport and trust; utilize unhurried and calm approach.
    • Utilize clear communication; address patient by name, speak slowly with simple directions and gestures; provide time for patient response, listen carefully and maintain eye contact.
    • Provide environmental adaptations to support cognitive function and safety; consider sensory exposure, hearing ability and distractions.
    • Establish familiarity using a structured routine congruent with home schedule, when possible, such as family presence, consistent caregiver, sleep and meal schedule, toileting schedule.
    • Provide conducive environment for sleep, such as uninterrupted sleep times and light therapy.
    • Optimize nutrition and fluid intake; encourage and offer fluid intake frequently and assist with meal set-up and feeding if needed.
    • Encourage multimodal physical activity, exercise and complementary interventions, such as mind-body exercise; consider combined exercise and cognitive activity.
    • Implement cognitive remediation or restorative techniques, such as training in direct attention, occupation, activity-based and functional communication strategies.

    Associated Documentation

    • Environment Familiarity/Consistency
    • Self-Care Promotion
    • Sensory Stimulation Regulation

    Education

    CPG-Specific Education Topics

    Overview

    • risk factors

    • signs/symptoms

    Self-Management

    • activity

    • assistive/adaptive devices

    • cognitive support measures

    • home safety

    • provider follow-up

    • rehabilitation therapy

    When to Seek Medical Attention

    • unresolved/worsening symptoms

    General Education Topics

    General Education

    • admission, transition of care

    • orientation to care setting, routine

    • advance care planning

    • diagnostic tests/procedures

    • diet modification

    • opioid medication management

    • oral health

    • medication management

    • pain assessment process

    • safe medication disposal

    • tobacco use, smoke exposure

    • treatment plan

    Safety Education

    • call light use

    • equipment/home supplies

    • fall prevention

    • harm prevention

    • infection prevention

    • MDRO (multidrug-resistant organism) care

    • personal health information

    • resources for support

    References

    • (2019). Lazaro, R. T.; Reina-Guerra, S. G.; Quiben, M (Eds.), Umphred's Neurological Rehabilitation. St. Louis: Elsevier. [Expert/Committee Opinion]
    • Austrom, M. G.; Boustani, M.; LaMantia, M. A. Ongoing medical management to maximize health and well-being for persons living with dementia. The Gerontologist. 2018;58(S1), S48-S57. doi:10.1093/geront/gnx147 Source[Review Articles]
    • Bahar-Fuchs, A.; Martyr, A.; Goh, A. M.; Sabates, J.; Clare, L.. Cognitive training for people with mild to moderate dementia. Cochrane Database of Systematic Reviews. 2019;3(3) doi:10.1002/14651858 [Systematic Review]
    • Basak, C.; Qin, S.; O'Connell, M. A. Differential effects of cognitive training modules in healthy aging and mild cognitive impairment: A comprehensive meta-analysis of randomized controlled trials. Psychology and Aging. 2020;35(2), 220-249. doi:10.1037/pag0000442 Source[Meta-analysis]
    • Brandt, Å.; Jensen, M. P.; Søberg, M. S.; Andersen, S. D.; Sund, T. Information and communication technology-based assistive technology to compensate for impaired cognition in everyday life: A systematic review. Disability and Rehabilitation: Assistive Technology. 2020;15(7), 810-824. doi:10.1080/17483107.2020.1765032 Source[Systematic Review]
    • Brenes, G. A.; Sohl, S.; Wells, R. E.; Befus, D.; Campos, C. L.; Danhauer, S. C.. The effects of yoga on patients with mild cognitive impairment and dementia: A scoping review. American Journal of Geriatric Psychiatry. 2019;27(2), 188-197. doi:10.1016/j.jagp.2018.10.013 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Bruderer-Hofstetter, M.; Rausch-Osthoff, A. K.; Meichtry, A.; Münzer, T.; Niedermann, K. Effective multicomponent interventions in comparison to active control and no interventions on physical capacity, cognitive function and instrumental activities of daily living in elderly people with and without mild impaired cognition–a systematic review and network meta-analysis. Ageing Research Reviews. 2018;45, 1-14. doi:10.1016/j.arr.2018.04.002 [Metasynthesis,Meta-analysis,Systematic Review]
    • Cicerone, K. D.; Goldin, Y.; Ganci, K.; Rosenbaum, A.; Wethe, J. V.; Langenbahn, D. M.; Malec, J. F.; Bergquist, T. F.; Kingsley, K.; Nagele, D.; Trexler, L.; Fraas, M.; Bogdanova, Y.; Harley, J. P. Evidence-based cognitive rehabilitation: Systematic review of the literature from 2009 through 2014. Archives of Physical Medicine and Rehabilitation. 2019; doi:10.1016/j.apmr.2019.02.011 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Dauwan, M.; Begemann, M. J.; Slot, M. I.; Lee, E. H.; Scheltens, P.; Sommer, I. E. Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials. Journal of Neurology. 2019;, 1-25. doi:10.1007/s00415-019-09493-9 [Metasynthesis,Meta-analysis,Systematic Review]
    • Demurtas, J.; Schoene, D.; Torbahn, G.; Marengoni, A.; Grande, G.; Zou, L.; et al. Physical activity and exercise in mild cognitive impairment and dementia: An umbrella review of intervention and observational studies. Journal of the American Medical Directors Association. 2020;21(10), 1415-1422. doi:10.1016/j.jamda.2020.08.031 Source[Systematic Review]
    • Dequanter, S.; Gagnon, M. P.; Ndiaye, M. A.; Gorus, E.; Fobelets, M.; Giguère, A.; et al . The effectiveness of E-health solutions for ageing with cognitive impairment: A systematic review. The Gerontologist. 2020;, 1-22. doi:10.1093/geront/gnaa065 Source[Systematic Review]
    • D’Rozario, A. L.; Chapman, J.; Phillips, C. L.; Palmer, J. R.; Hoyos, C. M.; Mowszowski, L.; et al. Objective measurement of sleep in mild cognitive impairment: A systematic review and meta-analysis. Sleep Medicine Reviews. 2020;52, 1-17. doi:10.1016/j.smrv.2020.101308 Source[Meta-analysis,Systematic Review]
    • Erickson, K. I.; Hillman, C.; Stillman, C. M.; Ballard, R. M.; Bloodgood, B.; Conroy, D. E.; Macko, R.; Marquez, D. X.; Petruzzello, S. J.; Powell, K. E. Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines. Medicine and Science in Sports and Exercise. 2019;51(6), 1242-1251. doi:10.1249/MSS.0000000000001936 [Metasynthesis,Meta-analysis,Systematic Review]
    • Fazio, S.; Stocking, J.; Kuhn, B.; Doroy, A.; Blackmon, E.; Young, H. M.; Adams, J. Y. How much do hospitalized adults move? A systematic review and meta-analysis. Applied Nursing Research. 2020;51, 1-10. doi:10.1016/j.apnr.2019.151189 Source[Meta-analysis,Systematic Review]
    • Fogg, C.; Griffiths, P.; Meredith, P.; Bridges, J.. Hospital outcomes of older people with cognitive impairment: an integrative review. International Journal of Geriatric Psychiatry. 2018;33(9), 1177-1197. doi:10.1002/gps.4919 [Review Articles]
    • Gates, N. J.; Vernooij, R. W.; Di Nisio, M.; Karim, S.; March, E.; Martinez, G.; et al. Computerised cognitive training for preventing dementia in people with mild cognitive impairment. Cochrane Database of Systematic Reviews. 2019;(3), 1-121. doi:10.1002/14651858.CD012279.pub2 [Meta-analysis,Systematic Review]
    • Gulanick, M.; Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions and outcomes. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Haugen, N.; Galura, S. (2020). Ulrich and Canale's Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • He, W.: Wang, M.; Jiang, L.; Li, M.; Han, X. Cognitive interventions for mild cognitive impairment and dementia: An overview of systematic reviews. Complementary Therapies in Medicine. 2019;47, 1-10. doi:10.1016/j.ctim.2019.102199 Source[Meta-analysis,Systematic Review]
    • Hwang, A. B.; Boes, S.; Nyffeler, T.; Schuepfer, G. Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. PloS One. 2019;14(7) doi:10.1371/journal.pone.0219569 Source[Metasynthesis,Meta-analysis,Systematic Review]
    • Kim, O.; Pang, Y.; Kim, J. H. The effectiveness of virtual reality for people with mild cognitive impairment or dementia: a meta-analysis. BMC Psychiatry. 2019;19(1), 219. doi:10.1186/s12888-019-2180 [Metasynthesis,Meta-analysis,Systematic Review]
    • Kruse, C. S.; Fohn, J.; Umunnakwe, G.; Patel, K.; Patel, S. Evaluating the Facilitators, Barriers, and Medical Outcomes Commensurate with the Use of Assistive Technology to Support People with Dementia: A Systematic Review Literature. Healthcare . 2020;8(3), 278-322. doi:10.3390/healthcare8030278 Source[Systematic Review]
    • Lai, X.; Wen, H.; Li, Y.; Lu, L.; Tang, C. The Comparative Efficacy of Multiple Interventions for Mild Cognitive Impairment in Alzheimer's Disease: A Bayesian Network Meta-Analysis. Frontiers in Aging Neuroscience. 2020;12(121), 1-12. doi:10.1155/2020/3620534 Source[Meta-analysis]
    • Law, L. L. F.; Barnett, F.; Yau, M. K.; Gray, M. A. Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: A systematic review. Ageing Research Reviews. 2014;(15), 61-75. [Metasynthesis,Meta-analysis,Systematic Review]
    • Leong, R. L.; Cheng, G. H. L.; Chee, M. W.; Lo, J. C. The effects of sleep on prospective memory: A systematic review and meta-analysis. Sleep Medicine Reviews. 2019; doi:10.1186/s12888-019-2180-x [Metasynthesis,Meta-analysis,Systematic Review]
    • Li, W.; Wang, Q.; Du, S.; Pu, Y.; Xu, G. Acupuncture for mild cognitive impairment in elderly people: Systematic review and meta-analyses. Medicine. 2020;99(39) doi:10.1097/MD.0000000000022365 Source[Meta-analysis,Systematic Review]
    • Liang, J. H.; Xu, Y.; Lin, L.; Jia, R. X.; Zhang, H. B.; Hang, L. Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis. Medicine. 2018;97(20) doi:10.1097/MD.0000000000010744 Source[Metasynthesis,Meta-analysis,Systematic Review]
    • Loprinzi, P. D.; Blough, J.; Ryu, S.; Kang, M. Experimental effects of exercise on memory function among mild cognitive impairment: systematic review and meta-analysis. The Physician and Sports Medicine. 2019;47(1), 21-26. doi:10.1080/00913847.2018.1527647 [Metasynthesis,Meta-analysis,Systematic Review]
    • Mamo, S. K.; Reed, N. S.; Price, C.; Occhipinti, D.; Pletnikova, A.; Lin, F. R.; Oh, E. S. Hearing loss treatment in older adults with cognitive impairment: A systematic review. Journal of Speech, Language, and Hearing Research. 2018;61(10), 2589-2603. doi:10.1044/2018_JSLHR-H-18-0077 Source[Systematic Review]
    • Miotto, E. C.; Batista, A. X.; Simon, S. S.; Hampstead, B. M. Neurophysiologic and cognitive changes arising from cognitive training interventions in persons with mild cognitive impairment: a systematic review. Neural Plasticity. 2018;2018, 1-14. doi:10.1155/2018/7301530 Source[Systematic Review]
    • Naef, R.; Ernst, J.; Burgi, C.; Petry, H.. Quality of acute care for persons with cognitive impairment and their families: a scoping review. International Journal of Nursing Studies. 2018;85, 80-89. doi:10.1016/j.ijnurstu.2018.05.006 [Review Articles,Systematic Review]
    • National Institute for Health and Care Excellence (NICE). (2018). Dementia: Assessment, management and support for people living with dementia and their carers. Source[Quality Measures,Clinical Practice Guidelines]
    • Oliva, H. N. P.; Machado, F. S. M.; Rodrigues, V. D.; Leão, L. L.; Monteiro-Júnior, R. S. The effect of dual-task training on cognition of people with different clinical conditions: An overview of systematic reviews. IBRO Reports. 2020;9, 24-31. doi:10.1016/j.ibror.2020.06.005 Source[Review Articles,Systematic Review]
    • O’Caoimh, R.; Mannion, H.; Sezgin, D.; O’Donovan, M. R.; Liew, A.; Molloy, D. W. Non-pharmacological treatments for sleep disturbance in mild cognitive impairment and dementia: A systematic review and meta-analysis. Maturitas. 2019;127, 82-94. doi:10.1016/j.maturitas.2019.06.007 Source[Meta-analysis,Systematic Review]
    • Patnode, C. D.; Perdue, L. A.; Rossom, R. C.; Rushkin, M. C.; Redmond, N.; Thomas, R. G.; Lin, J. S.. (2020, Feb). Screening for cognitive impairment in older adults: an evidence update for the U. S. preventative services task force. (Report No. 19-05257-EF-1)Rockvile, MD: Agency for Healthcare Research and Quality (US).Source[Position Statements]
    • Pendleton, H. M.; Schultz-Krohn, W. (2018). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Petersen, R. C.; Lopez, O.; Armstrong, M. J.; Getchius, T. S.; Ganguli, M.; Gloss, D.; Gronseth, G. S.; Marson, D.; Pringsheim, T.; Day, G. S.; Sager, M.; Stevens, J.; Rae Grant, A. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018, Jan;90(3), 126-135. doi:10.1212/WNL.000000000000482 [Quality Measures,Clinical Practice Guidelines]
    • Petersen, R. C.; Lopez, O.; Armstrong, M. J.; Getchius, T. S.; Ganguli, M.; Gloss, D.; Gronseth, G. S.; Marson, D.; Pringsheim, T.; Day, G. S.; Sager, M.; Stevens, J.; Rae Grant, A. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018, Jan;90(3), 126-135. doi:10.1212/WNL.000000000000482 [Quality Measures,Clinical Practice Guidelines]
    • Reilly, J. C.: Houghton, C. The experiences and perceptions of care in acute settings for patients living with dementia: A qualitative evidence synthesis. International Journal of Nursing Studies. 2019;96, 82-90. doi:10.1016/j.ijnurstu.2019.04.018 Source[Review Articles]
    • Reuben, D. B.; Herr, K. A.; Pacala, J. T.; Pollock, B. G.; Potter, J. F.; Semla, T. P. (2017). Geriatrics at your fingertips 2017. (pp.73-79). New York: American Geriatrics Society. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Russell-Williams, J.; Jaroudi, W.; Perich, T.; Hoscheidt, S.; El Haj, M.; Moustafa, A. A. Mindfulness and meditation: Treating cognitive impairment and reducing stress in dementia. Reviews in the Neurosciences. 2018;29(7), 791-804. doi:10.1515/revneuro-2017-0066 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Sehn, L. F. B.: Schuch, F. B.: Firth, J.: de Souza Stigger, F. Effects of physical exercise on cognitive function of older adults with mild cognitive impairment: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics. 2020;89, 1-10. doi:10.1016/j.archger.2020.104048 Source[Meta-analysis,Systematic Review]
    • Song, D.; Doris, S. F.; Li, P. W.; Lei, Y. The effectiveness of physical exercise on cognitive and psychological outcomes in individuals with mild cognitive impairment: A systematic review and meta-analysis. International Journal of Nursing Studies. 2018;79, 155-164. doi:10.1016/j.ijnurstu.2018.01.002 [Metasynthesis,Meta-analysis,Systematic Review]
    • Swearingen, P. L.; Wright, J. (2019). All-in-One Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. Philadelphia: Elsevier Health Sciences. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Wang, Y. Q.; Jia, R. X.; Liang, J. H.; Li, J.; Qian, S.; Li, J. Y.; et al . Effects of non‐pharmacological therapies for people with mild cognitive impairment. A Bayesian network meta‐analysis. International Journal of Geriatric Psychiatry. 2020;35(6), 591-600. doi:10.1002/gps.5289 Source[Meta-analysis]
    • Yang, H. L.; Chan, P. T.; Chang, P. C.; Chiu, H. L.; Hsiao, S. T. S.; chu, H.; Chou, K. R. Memory-focused interventions for people with cognitive disorders: A systematic review and meta-analysis of randomized controlled studies. International Journal of Nursing Studies. 2017;78, 44-51. doi:10.1016/j.ijnurstu.2017.08.005 [Metasynthesis,Meta-analysis,Systematic Review]
    • Yang, J.; Zhang, L.; Tang, Q.; Wang, F.; Li, Y.; Peng, H.; et al . Tai Chi is effective in delaying cognitive decline in older adults with mild cognitive impairment: Evidence from a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2020;2020, 1-11. doi:10.1155/2020/3620534 Source[Meta-analysis,Systematic Review]
    • Yang, Q.; Tian, C.; Tseng, B.; Zhang, B.; Huang, S.; Jin, S.; et al. Gait change in dual-task as a behavioral marker to detect mild cognitive impairment in the elderly-A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2020;101(10), 1818-1821. doi:10.1016/j.apmr.2020.05.020 Source[Meta-analysis,Systematic Review]
    • Zhang, H.; Huntley, J.; Bhome, R.; Holmes, B.; Cahill, J.; Gould, R. L.; et al. Effect of computerised cognitive training on cognitive outcomes in mild cognitive impairment: A systematic review and meta-analysis. BMJ Open. 2019;9(8), 1-10. doi:10.1136/bmjopen-2018-027062 Source[Meta-analysis,Systematic Review]
    • Zhou, X. L.; Wang, L. N.; Wang, J.; Zhou, L.; Shen, X. H . Effects of exercise interventions for specific cognitive domains in old adults with mild cognitive impairment: A meta-analysis and subgroup analysis of randomized controlled trials. Medicine. 2020;99(31), 1-11. doi:10.1097/MD.0000000000020105 Source[Meta-analysis]
    • Zou, L.; Loprinz, P. D.; Yeung, A. S.; Zeng, N.; Huang, T. The beneficial effects of mind-body exercises for people with mild cognitive impairment: A systematic review with meta-analysis. Archives of Physical Medicine and Rehabilitation. 2019; doi:10.1016/j.apmr.2019.03.009 Source[Metasynthesis,Meta-analysis,Systematic Review]

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