Detecting dementia among older, ethnically diverse residents of rural subsidized housing.
Lisa Kirk Wiese, Christine L Williams, Debra Hain and 4 others
PMID 33039199WHAT IT FOUND
Geriatric nurse practitioners did home memory assessments for older residents who screened positive, and 25 of 28 referred residents completed primary care visits.
Screening, home assessment, and provider referral happened together, so no single step can be credited.
Key findings
01Of 139 residents who met criteria, 28 screened at risk on the Mini-Cog, and 25 accepted the nurse practitioner home visit.
02All 25 who had the home assessment scored at risk on both the MoCA-B and QDRS, and the nurse practitioner agreement with the research assistant screen was 100%.
03Of 28 referred to a primary care provider, 25 completed an appointment; 15 started new medication and 6 were referred to neurology.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no control group or random allocation, so the study cannot show that the nurse practitioner home visit caused the referrals or medication changes. The study was descriptive and correlational, focused on feasibility, agreement, and follow-through rather than patient outcomes such as function, safety, mood, or quality of life. Only 28 people screened positive and 25 had home assessments, so the findings rest on a small at-risk subgroup. Participants lived in government-subsidized senior housing in one rural Florida area and were mostly African American, Afro-Caribbean, or Hispanic, so results may not apply to other communities or to people less willing to let a nurse into their home. Most participants lived alone and may have welcomed visits partly for social contact, which could inflate acceptance of home assessment. Provider feedback was very limited: only six of ten primary care providers returned the survey.
Declared interests
The authors declared no conflicts of interest. The paper is indexed as supported by NIH and non-U.S. government research funding.
The easy way to misread this
Do not read the 15 of 25 new medication starts as proof that nurse practitioner home assessment treats dementia or improves outcomes. The study had no control group, no clinical outcome measures, and the pathway included screening, home assessment, report to the provider, and provider decisions, so the contribution of any single component cannot be separated.