The underdetection of cognitive impairment in nursing homes in the Dublin area. The need for on-going cognitive assessment
Bibliographic record
Abstract
Sampling of NHs:\nAll general private and voluntary NHs belonging to the former Irish Health Service Executive East Coast Area (Dublin Mid-Leinster) were sampled. Three areas, namely 1, (Dun Laoire), 2 (Dublin South East) and 10 (Wicklow) which represent the former East Coast Eastern Regional Health Authority provided the sampling frame. Four of the 53 NHs were randomly selected. The chance of a NH being sampled was directly proportional to its size.\n\nSampling of residents:\nThe total capacity of the four NHs was 187 beds, and at the time of study, 174 beds were occupied. A sample of 100 residents was randomly drawn, 25 from each NH. Over-sampling occurred at each facility to allow for refusals (please see Appendix 1 in the supplementary data available on the journal website at http://www.ageing.oxfordjournals.org). Only 18 residents or their next of kin refused participation. The MMSE was administered to all 100 residents.\n\nEthical considerations:\nEthical approval was granted by Trinity College Dublin. Informed consent was obtained in all NHs, and proxy consent got for those residents known to lack capacity.\n\nInstruments:\nThe MMSE was used to assess CI [14]. When used for screening purposes, a cut score of 23/24 is conventionally used for detection of significant impairment. In contrast when the intention is to classify CI severity as was the case in this study, Folstein et al. recommendations were followed, i.e. normal cognitive function = 27?30, mild CI (MCI) = 21?26, moderate CI = 11?20 and severe CI = 0?10.\n\nResidents who scored within the normal ranges (MMSE ? 27) were re-assessed using the Montreal Cognitive Assessment (MoCA). The MoCA test is a screening instrument for the detection of mild CI. It was developed to discriminate individuals between mild CI and normal cognitive function [15]. The MoCA test scores 0?30 points. Scores of 26 or above are considered normal. Where residents were classified on the MMSE as severely impaired (MMSE ? 10), a proxy appraisal (the Dementia Screening Scale, DSS) was completed [The DSS total score varies between 0 and 14 with higher scores indicating worse CI [8]]. Using a Likert scale (no impairment, mild, moderate and severe), Directors of Nursing (DONs) perception of resident's cognitive status was also assessed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".