RECOGNITION OF COGNITIVE IMPAIRMENT BY DAY AND NIGHT NURSING STAFF AMONG ACUTE GERIATRIC-PATIENTS

The recognition of cognitive impairment by day and night nursing staff was studied in an acute geriatric unit. Seventy-six patients were ran domly selected from a prospective sample of admissions. DSM-III-R diag noses were established on all patients. Day and night staff were inter viewed about each patient's clinical condition and asked to state whet her or not they thought they were cognitively impaired or confused. Da y staff were reasonably good at differentiating cognitively unimpaired from those with dementia and or delirium [kappa=0.62, 95% confidence interval (Cl)=0.46-0.78]. All patients thought by day staff to be cogn itively impaired were found to be so, although day staff did fail to i dentify some patients with cognitive impairment. Night staff performed less well (kappa=0.37, 95% Cl 0.18-0.57) and identified cognitively n ormal patients as being cognitively impaired, as well as failing to id entify patients who were cognitively impaired. Night nursing interview s were not thought to have contributed to the management of any patien t. The usefulness of night-time nursing interviews for research and ge neral inpatient management purposes is questioned and the importance o f daytime nursing interviews emphasized.