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Use of the QuickSort with older adults whose lifestyle decision-making capacity is being questioned

Published online by Cambridge University Press:  16 September 2022

A. M. Foran Open the ORCID record for A. M. Foran [Opens in a new window] ,
J. L. Mathias Open the ORCID record for J. L. Mathias [Opens in a new window]  and
S. C. Bowden Open the ORCID record for S. C. Bowden [Opens in a new window]
A. M. Foran*
Affiliation:
School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
J. L. Mathias
Affiliation:
School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
S. C. Bowden
Affiliation:
School of Psychological Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, VI 3010, Australia
*
Corresponding author: A. M. Foran, Email: amie.foran@adelaide.edu.au
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Abstract

Objectives:

Cognitive impairment affects older adults’ capacity to live independently and make lifestyle decisions (lifestyle decision-making capacity; LS-DMC). Cognitive screens and clinical interviews are often used to assess people’s need for living-supports prior to conducting comprehensive LS-DMC assessments in busy clinical settings. This study investigated whether the QuickSort – a brief new cognitive screen – provides efficient and accurate information regarding patients’ LS-DMC when initially interviewed.

Methods:

This is an observational and diagnostic accuracy study of older inpatients (≥60 years) consecutively referred for neuropsychological assessment of LS-DMC (n = 124). The resources required by inpatients with questionable LS-DMC were quantified (length of hospital stay, living-supports). QuickSort scores, patient background information, and two common cognitive screens were used to differentiate between older inpatients (n = 124) who lacked (64%)/did not-lack (36%) LS-DMC.

Results:

Hospitalizations averaged 49 days, with 62% of inpatients being readmitted within one year. The QuickSort differentiated between those lacking/not-lacking LS-DMC better than two common cognitive screens and patient information. The likelihood that inpatients lacked LS-DMC increased by a factor of 65.26 for QuickSort scores <2 and reduced by a factor of 0.32 for scores ≥13. Modeling revealed that the post-test likelihood of lacking LS-DMC increased to 99% (scores <2) and reduced to 30% (scores ≥ 13) in settings where many inpatients lack LS-DMC.

Conclusions:

Older adult inpatients with questionable LS-DMC have a high risk of extended hospitalization and readmission. The QuickSort provides time-efficient and sensitive information regarding patients’ LS-DMC, making it a viable alternative to longer cognitive screens that are used at the initial interview stage.

Keywords

ScreenCognitionDecision-making capacityLifestyleOlder adults
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 29 , Issue 5 , June 2023 , pp. 480 - 491
Copyright
Copyright © INS. Published by Cambridge University Press, 2022

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