Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients
Contributing GEDC Faculty
Dr. Ula Hwang is the Medical Director for Geriatric Emergency Medicine at New York University and a core investigator at the GRECC (Geriatrics Research, Education and Clinical Center) at the James J. Peters Bronx VAMC. Her research focuses on improving the quality of care older adults receive in the ED setting that ranges from observational studies of analgesic safety and effectiveness in older patients to multi-center implementation science studies of geriatric emergency care interventions. Hwang currently co-PIs the Geriatric Emergency Department Collaborative and is the PI on the Geriatric Emergency care Applied Research (GEAR) network.
Dr. Michael Malone is the Medical Director of Aurora Health Care - Senior Services and the Aurora at Home. He is a Clinical Adjunct Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. He also serves as the Director of the Geriatrics Fellowship Program at Aurora Health Care. Dr. Malone received his undergraduate and medical degrees from Texas Tech University in Lubbock, Texas; he completed his internal medicine residency and geriatric fellowship training at Mt. Sinai Medical Center in Milwaukee. His Aurora Health Care practice is to home-bound older persons in inner-city Milwaukee.
Dr. Don Melady is an emergency physician at Mount Sinai Hospital in Toronto, Canada and a founding member of the Geriatric Emergency Department Collaborative. He is the author of the website www.geri-EM.com – a CME accredited program for geriatric emergency medicine education – and the chair of the Geriatric EM committee of the International Federation of Emergency Medicine.
Abstract
In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included:
- recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;
- emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; and
- recognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.