Screening of the cognitive state as an important precondition of empirical research among older populations

The occurrence of cognitive impairments is a relevant aspect when conducting quantitative surveys on older people in nursing homes. In Germany about 60% of residents are suffering from dementia. Therefore, regarding self-report methods, the reliability of responsiveness can be questioned for cognitive impaired people. Thus, specific sampling strategies and methods like proxy assessments or non-reactive measures are needed.

Pain is a common phenomenon among people of advanced age. The project “Action Alliance Pain-free City Münster” was analysing this phenomenon in various health care facilities in one city. In this presentation – using the example of our study of 436 residents in 13 nursing homes – challenges in conducting research in older populations will be discussed and the projects’ research design to cope with the complicacy including populations with cognitive impairments will be presented.

Because pain is of great subjective perception among affected people, methods which rely on patients self-reports should be given priority. The reliable usage of such methods for patients with severe cognitive impairments is limited. In our study, one specific strategy regarding this challenge was conducted: the Mini-Mental-State-Examination (MMSE) was used to assess the grade of cognitive impairment. According to this screening, three patient groups were distinguished and specific methods to explore their pain suffering were adopted. Patients with no or mild impairments were interviewed with questionnaires, patients with severe impairments were observed using proxy assessments. The group with moderate impairments was examined using both, questionnaires as well as proxy assessments.

It is argued that the screening of the cognitive state should be seen as a necessity in empirical studies among people of advanced age. As one possible practical screening tool the MMSE is recommended. Depending on the cognitive state, a mix of self- and proxy-research methods might be an adequate strategy to achieve reliable results.