title: Ineffective communication of mental status information during care transfer of older adults.
abstract: BACKGROUND
  Monitoring and documenting the mental status of older patients transferred between providers or facilities is important because mental status change can be a sign of acute disease and mental status abnormalities necessitate specific approaches to care.
  
  
  OBJECTIVE
  To identify patient and illness factors associated with presence of a mental status description in inter-facility transfer documents and to describe the content and concurrent validity of transfer mental status descriptions when they occur.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Individuals transferred between 5 long-term and 2 acute care facilities in an urban setting.
  
  
  METHODS
  Trained research personnel reviewed hospital and nursing home medical records and inter-facility transfer documents. Mental status descriptions in transfer documents were coded as abnormal or normal within 5 domains: alertness, communication, orientation/memory, behavior, and mood. Descriptions were compared with mental status items in the nursing home Minimum Data Set and in a transfer communication checklist.
  
  
  RESULTS
  In all, 123 nursing home residents experienced 174 hospital admissions. Mental status descriptions were present in 69% of transfer documents. A total of 67% of patients missing a transfer mental status description upon nursing home-to-hospital transfer had dementia. Factors associated with presence of a transfer mental status description were urgent transfer, nursing home of origin, and among patients without dementia, greater cognitive impairment. When present, a mean of 1.47 (SD=0.81) cognitive domains were documented in transfer mental status descriptions. Agreement between transfer mental status descriptions and comparison sources was fair to good (kappa=.31 to .73).
  
  
  CONCLUSIONS
  Mental status documentation during transfer of older adults between nursing home and hospital did not identify all patients with dementia and did not completely characterize patients' cognitive status.
authors.affiliation: Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, NY 10468, USA. kenneth.boockvar@mssm.edu
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Boockvar
authors.forename: Bella
authors.initials: B
authors.lastname: Fridman
authors.forename: Cinthya
authors.initials: C
authors.lastname: Marturano
mesh_terms: D000367:Age Factors; D003072:Cognition Disorders; D003142:Communication; D003704:Dementia; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D005791:Patient Care; D010360:Patient Transfer; D012189:Retrospective Studies; D014505:Urban Population