The Cognitive Functional Hardship Survey Results
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Last month, nearly 500 of you participated in a BCAT national online survey.  Let me begin this post by thanking you for your responses.  Our empirical investigations often begin with critical input from professionals in the field.  Your feedback is very important to us.

At our research center, we are currently engaged in two important projects.  First, we are working on the development of a construct called cognitive-functional hardship (CFH) which will help identify at-risk adults and older adults in the community.  The term “at-risk” refers to people who have challenges performing everyday tasks due to cognitive impairments, especially in the area of judgment. Second, we are developing a new test of practical judgment.  The survey you completed was relevant to both projects.  As there were more data collected than could be reported in this brief post, I present a summary in three sections: demographics of survey respondents, specific information about CFH, and your responses about the need for a new test of practical judgment.

Key Demographics of Survey Participants

  • Average age: 50 years
  • Average number of years of experience in healthcare: 20
  • Average number of years in geriatrics: 17
  • Healthcare domain: 45% rehab therapists, 11% social workers, 8% nurses, 14% “other” (e.g., physicians, psychologists, geriatric care managers)
  • Respondents were from 38 US states, Washington, DC, Europe, Canada, and Africa.


Cognitive-Functional Hardship (CFH)

Cognitive-functional hardship is defined as the difficulty one experiences in independently maintaining one’s home environment and performing (without assistance) everyday activities as a result of cognitive decline.  Persons with CFH have difficulties performing activities of daily living (ADLs) and / or instrumental activities of daily living (IADL) because of cognitive deficits.  In the survey, we asked respondents to indicate how many deficits in ADL and / or IADL domains would be required for a person to meet the threshold of CFH.  

  • Of the six ADLs identified (feeding, continence, transferring, toileting, dressing, bathing), respondents indicated that a person with deficits in two or more areas would meet the threshold of CFH.
  • Of the eight IADLs identified (using the telephone, shopping, preparing food, housekeeping, doing laundry, using transportation, handling medications, handling finances), respondents indicated that a person with deficits in two or more areas would meet the threshold for CFH.
  • Deficits in two or more areas of either variable was deemed necessary and sufficient for a person to meet the threshold for CFH. That is, CFH was defined as two or more deficits in either ADLs or IADLs.  When a person has deficits in two ADL areas or two IADL areas, she/he is said to have CFH.

A New Test of Practical Judgment

Unfortunately, there are relatively few brief tests of practical judgment with solid psychometrics.  The BCAT Kitchen Picture Test is certainly one of them, but it is designed to identify persons with more severe deficits in judgment.  There is also a need for a brief test to identify more subtle deficits in judgment and to predict CFH.  While the BCAT and BCAT-SF can be used to predict CFH, our goal is to develop a rapid judgment test that can also be used to identify adults and older adults at risk for ADL and IADL deficits.  Once CFH is identified, a plan can be developed to protect vulnerable individuals at-risk for a myriad of problems, including falls, re-hospitalizations, medication errors, and other injuries.

We asked survey respondents whether CFH is a useful construct for identifying risk in adults and older adults. Respondents confirmed that CFH could be important for identifying people at risk for falls at home (81%), re-hospitalization (72%), and medication errors (93%).  In addition, respondents indicated that CFH could indicate who would benefit from home care (87%), a caregiver (92%), alternate housing (84%), telehealth (89%), and improved social support (93%).

Lastly, we asked how respondents currently assess judgment. We learned that, while the majority of survey respondents assess practical judgment informally (85%), only 38% use a formal assessment instrument to do so.  Once validation studies are complete, we hope that our new test of practical judgment will provide professionals in geriatrics with an effective tool for assessing judgment and predicting CFH.

We plan to share more information about the new judgment instrument and the application of CFH in the near future. Stay tuned!

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