MEMORY AWARENESS IN NURSING-HOME RESIDENTS

Background: Health care providers often believe that individuals with cognitive disturbance are unaware of their deficits. The term unawaren ess was first used to describe hemiplegia following right hemisphere s troke but has since been applied to unawareness of any neurological or neuropsychological deficit. Clinicians usually rely on their subjecti ve observations to evaluate the patient's awareness of deficits, and f ew investigators have systematically evaluated this important clinical phenomenon. Objective: The aim of this study was to compare cognition , depression, health, and metamemory (capacity, change, locus, and str ategy) in four groups of nursing home residents: the cognitively impai red (29%), depressed (18%), mixed with both cognitive impairment and d epression (32%), and controls (21%). Methods: Subjects were 106 reside nts of six nursing homes between the ages of 79 and 87 with a mean age of 84.18 (SD = 10.01) years, and an average of six comorbid medical c onditions. Cognitive function was measured with the Mini Mental State (MMSE); depression with the Geriatric Depression, and metamemory with the Meta-memory in Adulthood scales. Anyone scoring <15 on the MMSE wa s excluded. Subjects included 31 with cognitive impairment, 19 depress ed, 34 mixed, and 22 controls. Results: In this sample, 61% were cogni tively impaired; however, only 12 had a diagnosis in their records ind icating cognitive disturbance. Forty-three percent were depressed. The correlations between depression and capacity (r = -0.38), change (r = -0.50), and locus (r = -0.25) were significant. The controls were sig nificantly younger than the cognitively impaired group. The controls a lso had higher perceived health status scores than either the cognitiv ely impaired or the depressed group. However, the mixed group's percei ved health status scores were significantly higher than the depressed group's scores. Conclusion: The metamemory components of capacity and change were able to differentiate the cognitively impaired from the mi xed group. Information on the etiology of cognitive impairment was not available since residents' charts in the six nursing homes provided i nadequate documentation and incomplete diagnostic histories. Therefore , quantitative methods for examining memory awareness and the affectiv e state of elderly patients is important for clinicians in order to ma ke informed treatment decisions.