Assessing Mental Health of Geriatric Patient

Assessing Mental Health of Geriatric Patient

by Ricky Ocampo RN

Geriatric patients undergo a distinct change by the way they interpret things. Old age means weakened immune systems and lower cognitive responses (Cockrell & Folstein, 2002). As a result, it is important to treat geriatric patients with another means of examination. The discussing point would be to use the Mini-Mental State Examination or MMSE to test five areas of an elderly patient’s cognitive responses. Interpretations of the test would be utilized to understand the cognitive condition of the patient. Interventions would then be derived from these interpretations to enhance the treatment process of the geriatric patient. Additionally, an important discussing point would be the cognitive impairment presence in the patient, which will be analyzed after the results of the interview and examination are presented.

Geriatric Patient Information

The patient, whose identity is to remain confidential as per request, is a 68-year-old male, of Caucasian descent, and who has been recovering from depression. His wife died 15 years ago and he has recently recovered from his depression because of medication and family support. He has three children who are all professionals now, and he remarked on how happy he was to see that they were doing well. He used to work at the police force, so his cognitive abilities are above average. He has been a chain smoker until well into his 40s where bronchitis prompted him to stop. He did not drink much, only on occasions. The patient, with old age, has experienced his motor skills waning, but he could cope because of his police training. He feels that his body is not the same, but he is able to manage because of the fact that he jogs every day to keep up his energy levels and to promote metabolism. 

Upon the administration of the MMSE to the patient, the following points had been attained: he received 4 on Orientation to Time, 5 on Orientation to Place, 2 on Registration, 4 on Attention and Calculation, 3 on Recall, 2 on Language, 1 on Repetition, and 4 on Complex Commands. The possible points for each score had been based on the MMSE guidelines by Cockrell and Folstein (2002) as: 5 for Orientation to Time, 5 for Orientation to Place, 3 for Registration, 5 for Attention and Calculation, 3 for Recall, 2 for Language, 1 for Repetition, and 6 for Complex Commands. The total possible score would be 30.

MMSE Interpretation

Based on the results of the patient, he got a score of 25, which is slightly lower than the mean score of 27 as stated in Muir, Gopaul, and Odasso (2012). He manages to score high on specific portions such as Orientation to Place, Recall, Language, and Repetition due to his line of work as a police officer. He scored lowest on Complex Commands due to his degraded level of cognitive motor skills. 

Upon assessment, Orientation to Time had been the element of how a person perceives the arbitrary elements of past, present, and future. Cockrell and Folstein (2002) studied that the correlation effectiveness decreases as a person ages. The patient scored 4, which is only a subtle decrease.

Orientation to Place via deductive testing is presented by data from the broadest perspectives such as nations to the narrowest such as streets (Cockrell & Folstein, 2002). The patient scored a 5, the perfect score. It is very evident that the geographic element of being a police officer has strengthened his resolve to memorize and retain information on locations.

For Registration, the patient scored a 2. Registration is the repetition of prompts (Cockrell, & Folstein, 2002). The patient may have had a subtle decrease of registration due to the abundance of prompts he had to listen to throughout the years as a police officer. 

For Attention and Calculation, he scored a 4. Attention and Calculation would entail the ability to maintain a keen detail on a set of words or prompts (Cockrell & Folstein, 2002). One of the merits of police work is investigative work, so the patient has engraved such experience to memory.

Recall is the repetitive assessment of Registration, which the patient received a score of 3, which is the perfect score for this category. He also received perfect scores of 2 and 1 on Language and Repetition, respectively. The patient’s justification of the result is due to his experience as police officer in procedural analysis, which requires recall.

Lastly, the patient received a 4 out of 6 for Complex Commands. Because of cognitive performance decrease due to old age, the patient was not able to easily comprehend and execute the complex commands presented.

Having that interpretation, the patient receiving a score of 25 is just below the benchmark of 27 as normal cognition. Cockrell and Folstein (2002) stated that anything below 24 is mild cognitive impairment. So, the patient functions at normal cognition levels.

Cognitive Impairment Analysis and Conclusion

If the patient were to have cognitive impairment, the results of the MMSE would be very different. For instance, he would score low on Orientation to Time and Orientation to Place since these require a deep understanding of correlation. Moreover, he would also fail in Registration, Recall, Repetition, and Complex Commands, which require high cognitive abilities as well. According to Muir, Gopaul, and Odasso (2012), the MMSE is a good indicator of the cognitive levels of a patient. Cognitive impairment will produce a very different result because the patient would not be able to manage the tasks as easily as intended. As a result, the patient would have different treatment goals, especially those focused on intervention and cognitive stabilization.

References

Cockrell, J. R., & Folstein, M. F. (2002). Mini-mental state examination. Principles and practice of geriatric psychiatry, 140-141.

Muir, S. W., Gopaul, K., & Odasso, M. M. M. (2012). The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age and ageing, 41(3), 299-308.