Half of nursing home residents are also cognitively impaired 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.
The uplifting team led by Kathleen T. Unroe, MD, MHA, MS, and John G. Cagle, PhD reported in a peer-reviewed paper that the tools they enhanced reliably addressed physical and mental distress, as well as happiness and symptoms, precursors to terminal stage. 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 raised clinical trials to improve the quality of dementia care by building capacity in nursing homes.
People are being cared for in nursing homes. This is because there are important needs for daily activities and important needs for multiple complex and serious chronic diseases (activities of daily life). However, to address these needs, it is difficult to measure symptoms in residents, particularly those with cognitive disabilities. ”
Dr. Kathleen T. Unroh, senior author of the paper, research scientist at the Institute of Leganes and professor at the IU School of Medicine.
“In my 20 years as a clinician in nursing homes and researchers, information about the symptoms we want is often not consistently available in the data we have already collected, or at the frequency that we need to measure the impact of our programs and approaches. As a result, we have taken steps to validate commonly used equipment in a larger population (individuals currently living with cognitive impairments), 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. I hope that when the final results come in 2026, it will get excited and become a repeating model for implementing this much-needed type of care.”
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Journal Reference:
Cagle, J.G., et al. (2025). A staff-reported psychometric assessment of the Eold -CAD scale among nursing home residents with cognitive impairment. International Journal of Psychiatry for the Geriatrics. doi.org/10.1002/gps.70037.
