Managing cognitive impairment in the elderly: Conceptual, intervention andmethodological issues

Purpose (1) With the aging of society, the incidence of dementia in the elderly is also increasing, and thus results in increased numbers of individuals with cognitive impairment. Nurses and other researchers have investigated issues concerning the management of cognitive impairment. This article highlights conceptual, intervention and methodological issues associated with this ph enomenon. Conclusions (2) Cognitive change is a multivariate construct that includes alterations in a variety of information processing mechanisms such as problem solving a bility, memory, perception, attention and learning, and judgement. Although there is a large body of research, conceptual, intervention and methodolog ical issues remain. Much of the clinical research on cognitive impairment i s atheoretical, with this issue only recently being addressed. While many c linical interventions have been proposed, few have been adequately tested. There are also various methodological concerns, such as small sample sizes and limited statistical power; study design issues (experimental vs. non-ex perimental), and internal and external validity problems. Clearly, addition al research designed to intervene with these difficult behaviors is needed. Implications (3) A variety of psychosocial, environmental and physical parameters must b e considered in the nursing care of persons with cognitive impairment. Spec ial attention has been given to interventions associated with disruptive be haviors. Interventions are complex and knowledge must be integrated from bo th the biomedical and behavioral sciences in order to deal effectively with the numerous problems that can arise over a long and changing clinical cou rse. Some researchers and clinicians have suggested that a new culture rega rding dementia care is needed, one that focuses on changing attitudes and b eliefs about persons with dementia and one that changes how organizations d eliver that care. This review identifies key conceptual, intervention and m ethodological issues and recommends how these issues might be addressed in the future.