Improved tools ensure that you address physical and mental distress, happiness and end-of-life symptoms
INDIANAPOLIS – Half of nursing home residents also have cognitive impairments and may not be able to communicate symptoms such as pain and anxiety to the staff and clinicians who care for them. Therefore, the information needed to assess symptoms and subsequent treatment decisions is usually certainly not present in the nursing home electronic health records (EHR).
The new paper reports on new indications of commonly used symptom assessment instruments and obtains this challenging data more comprehensively with the ultimate goal of enabling the expansion of the knowledge base of palliative care services in nursing homes to address resident symptoms.
The paper is a part of a large, diverse, multifaceted uplift study – short for using institutional palliative leaders to transform the care of patients with Alzheimer's disease. The raised researchers modified the equipment originally designed for postmortem dementia to report, allowing nursing home staff and families to report moderate to severe dementia symptoms.
Leaded by Kathleen T. Unroe, MD, MHA, John G. Cagle and PhD, the excited team reported in a peer-reviewed paper that the tools they enhanced reliably addressed the physical and emotional distress and happiness and symptoms, which were precursors, until the end of life. This validation was important as researchers developed guidance for expanding symptoms recognition and management in any nursing home. The adoption of equipment used in other studies allows researchers to directly compare findings.
Dr. Dr. Kale, Dr. Kagul and colleagues (Legane Science Institute and IU School of Medicine) are in the late stages of uplifted clinical trials to improve the quality of dementia care by building capacity in nursing homes.
“People are being cared for in nursing homes because they have important needs for daily activities and important needs for multiple complex and serious chronic diseases (support for daily activities). However, in order to address these needs, it is difficult to measure symptoms, especially in people with cognitive impairments,” says Dr. Unroe, senior author of elevation. “In the 20 years of working as a clinician in a nursing home or researcher, information about the symptoms we want is often not consistently available in the data we have already collected, or as often as necessary to measure the impact of programs and approaches. And it's not always possible for cognitively impaired residents to know if someone has symptoms, such as asking someone to directly assess their symptoms if they have pain or anxiety. So we took steps to validate commonly used devices in a larger population (an individual currently living with cognitive impairment), adding additional necessary data points.
“While hospice care is usually available, there is a widespread awareness that more broader palliative care is needed in nursing homes. However, there is no roadmap for how to deliver it well. We hope that when the final results are obtained in 2026, the uplift proves to be a replicable model for implementing this much-needed type of care.
“Psychometric assessment of the Eold-CAD scale reported among nursing home residents with cognitive impairment” is published in the International Journal of Geriatric Psychiatry.
All authors and affiliations:
John G. Cagle1, Timothy E. Stump2, Wanzhu Tu2,3, Mary Ersek4, Alexander Floyd3, Lieve Van Den Block5, Peiyan Zhang1, Todd D. Becker1, Kathleen T. Unroe3,6.
1. University of Maryland University of Social Work, Baltimore, Maryland, USA. 2. Indianapolis, Indiana University, Faculty of Science, Biostatistics and Health Data Science. 3Regenstrief Institute, Inc, Indianapolis, Indiana, USA. 4 Veterans Issues, Philadelphia, Pennsylvania, USA. 5VUB-Gugent-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium. 6 Indiana University School of Medicine, Indianapolis, Indiana, USA.
Kathleen T. Unro, MD, MHA
In addition to being a research scientist at the Indiana University Center for Aging Research at the Leggas Street Institute of Maryland, she is a professor of medicine at the Indiana University School of Medicine and Geriatric Medicine.
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