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The Association of Judgement Ability and Functional Status in Older Adult Rehabilitation Inpatients

Published online by Cambridge University Press:  23 July 2018

C. G. Quinn
Affiliation:
Department of Psychology, The Graduate Center, The City University of New York, New York, NY, USA Department of Psychology, Queens College, The City University of New York, Queens, NY, USA Department of Psychology, Brooklyn College, The City University of New York, Brooklyn, NY, USA
L. A. Rabin
Affiliation:
Department of Psychology, The Graduate Center, The City University of New York, New York, NY, USA Department of Psychology, Queens College, The City University of New York, Queens, NY, USA Department of Psychology, Brooklyn College, The City University of New York, Brooklyn, NY, USA
G. C. Sprehn*
Affiliation:
Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
*
Address for correspondence: G. C. Sprehn, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA. E-mail: gsprehn@iupui.edu.
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Abstract

Purpose: Older adults have an increased likelihood of requiring rehabilitative care due to cognitive and physical risk factors. Research has found a link between executive functioning performance and functional outcomes; however, there is a dearth of research on the assessment of judgement ability. In the current pilot study, we investigated the clinical utility of the Test of Practical Judgment (TOP-J) in an older adult rehabilitation sample.

Methods: Inpatients of mixed diagnoses (n = 25, mean age = 72.60) completed the TOP-J and Functional Independence Measure (FIM). We assessed TOP-J performance in the entire sample and in those with intact vs. impaired global cognition (on the Mini-Mental State Examination; MMSE). Correlational analyses were conducted between the TOP-J, MMSE and relevant FIM items.

Results: TOP-J performance fell between the means typically observed in individuals with mild cognitive impairment and mild Alzheimer's disease. Participants with intact global cognition obtained significantly higher TOP-J scores than those with impaired global cognition. Moderate to strong positive correlations emerged between TOP-J, MMSE and FIM items of problem solving, comprehension and memory.

Conclusions: Results provide support for the clinical utility and validity of the TOP-J among older adults in the rehabilitation setting. Administering the TOP-J may help identify patients at risk for future injury and facilitate role transitions.

Type
Articles
Copyright
Copyright © Australasian Society for the Study of Brain Impairment 2018 

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References

Ambrose, A.F., Paul, G., & Hausdorff, J.M. (2013). Risk factors for falls among older adults: A review of the literature. Maturitas, 75 (1), 5161.Google Scholar
Ballard, C., Stephens, S., Kenny, R., Kalaria, R., Tovee, M., & O'Brien, J. (2003). Profile of neuropsychological deficits in older stroke survivors without dementia. Dementia and Geriatric Cognitive Disorders, 16 (1), 5256.Google Scholar
Centers for Disease Control and Prevention. (2014, March 17). Stroke: Risk factors. Retrieved from https://www.cdc.gov/stroke/risk_factors.htm.Google Scholar
Chumney, D., Nollinger, K., Shesko, K., Skop, K., Spencer, M., & Newton, R.A. (2010). Ability of functional independence measure to accurately predict functional outcome of stroke-specific population: Systematic review. Journal of Rehabilitation Research and Development, 47 (1), 17.Google Scholar
Clouston, S.A., Brewster, P., Kuh, D., Richards, M., Cooper, R., Hardy, R., . . . Hofer, S.M. (2013). The dynamic relationship between physical function and cognition in longitudinal aging cohorts. Epidemiologic Reviews, 35 (1), 3350.Google Scholar
Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135168.Google Scholar
Dodds, T.A., Martin, D.P., Stolov, W.C., & Deyo, R.A. (1993). A validation of the functional independence measurement and its performance among rehabilitation inpatients. Stroke, 74 (5), 6575.Google Scholar
Ellis, P.D. (2010). The essential guide to effect sizes: Statistical power, meta-analysis, and the interpretation of research results. New York: Cambridge University Press.Google Scholar
Field, A. (2013). Discovering statistics using IBM SPSS statistics (4th ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.Google Scholar
Furr, R.M., & Bacharach, V.R. (2013). Psychometrics: An introduction. Thousand Oaks, CA: Sage Publications.Google Scholar
Gabbe, B.J., Simpson, P.M., Sutherland, A.M., Williamson, O.D., Judson, R., Kossmann, T., & Cameron, P.A. (2008). Functional measures at discharge: Are they useful predictors of longer term outcomes for trauma registries? Annals of Surgery, 247 (5), 854859.Google Scholar
Granger, C., & Hamilton, B. (1985). Functional independence measure (FIM). New York: The Task Force for Development of a Uniform Data System for Medical Rehabilitation. Project Office, Department of Rehabilitation Medicine, Buffalo General Hospital.Google Scholar
Hanks, R.A., Rapport, L.J., Millis, S.R., & Deshpande, S.A. (1999). Measures of executive functioning as predictors of functional ability and social integration in a rehabilitation sample. Archives of Physical Medicine and Rehabilitation, 80 (9), 10301037.Google Scholar
Herman, T., Mirelman, A., Giladi, N., Schweiger, A., & Hausdorff, J.M. (2010). Executive control deficits as a prodrome to falls in healthy older adults: A prospective study linking thinking, walking, and falling. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 65A (10), 10861092.Google Scholar
Hobart, J.C., Lamping, D.L., Freeman, J.A., Langdon, D.W., McLellan, D.L., Greenwood, R.J., & Thompson, A.J. (2001). Evidence-based measurement: Which disability scale for neurologic rehabilitation? Neurology, 57 (4), 639644.Google Scholar
Kahokehr, A., Siegert, R.J., & Weatherall, M. (2004). The frequency of executive cognitive impairment in elderly rehabilitation inpatients. Journal of Geriatric Psychiatry and Neurology, 17 (2), 6872.Google Scholar
Kalaria, R.N. (2012). Cerebrovascular disease and mechanisms of cognitive impairment. Stroke, 43 (9), 25262534.Google Scholar
Kukull, W.A., Larson, E.B., Teri, L., Bowen, J., McCormick, W., & Pfanschmidt, M.L. (1994). The mini-mental state examination score and the clinical diagnosis of dementia. Journal of Clinical Epidemiology, 47 (9), 10611067.Google Scholar
LaBuda, J., & Lichtenberg, P. (1999). The role of cognition, depression, and awareness of deficit in predicting geriatric rehabilitation patients' IADL performance. The Clinical Neuropsychologist, 13 (3), 258267.Google Scholar
Lopez, M.N., Charter, R.A., Mostafavi, B., Nibut, L.P., & Smith, W.E. (2005). Psychometric properties of the folstein mini-mental state examination. Assessment, 12 (2), 137144.Google Scholar
MacDougall, E.E., & Mansbach, W.E. (2013). The judgment test of the neuropsychological assessment battery (NAB): Psychometric considerations in an assisted-living sample. The Clinical Neuropsychologist, 27 (5), 827839.Google Scholar
Martyr, A., & Clare, L. (2012). Executive function and activities of daily living in Alzheimer's disease: A correlational meta-analysis. Dementia and Geriatric Cognitive Disorders, 33 (2–3), 189203.Google Scholar
Mayo, A.M., Wallhagen, M., Cooper, B.A., Mehta, K., Ross, L., & Miller, B. (2013). The relationship between functional status and judgment/problem solving among individuals with dementia. International Journal of Geriatric Psychiatry, 28 (5), 514521.Google Scholar
Mirelman, A., Herman, T., Brozgol, M., Dorfman, M., Sprecher, E., Schweiger, A., . . . Hausdorff, J.M. (2012). Executive function and falls in older adults: New findings from a five-year prospective study link fall risk to cognition. Plos One, 7 (6), e40297.Google Scholar
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), 299308.Google Scholar
Ottenbacher, K.J., Hsu, Y., Granger, C.V., & Fiedler, R.C. (1996). The reliability of the functional independence measure: A quantitative review. Archives of Physical Medicine and Rehabilitation, 77 (12), 12261232.Google Scholar
Özdemir, F., Birtane, M., Tabatabaei, R., Ekuklu, G., & Kokino, S. (2001). Cognitive evaluation and functional outcome after stroke. American Journal of Physical Medicine & Rehabilitation, 80 (6), 410415.Google Scholar
Pohjasvaara, T., Leskelä, M., Vataja, R., Kalska, H., Ylikoski, R., Hietanen, M., . . . Erkinjuntti, T. (2002). Post-stroke depression, executive dysfunction and functional outcome. European Journal of Neurology, 9 (3), 269275.Google Scholar
Rabin, L.A., Aronov, A., Chi, S.Y., Fogel, J., Charcape, M.M., Borgos, M.J., & Saykin, A.J. (2013, February). The Test of Practical Judgment (TOP-J): Updated normative data and validation in a demographically diverse group of older adults. Presented at the Annual Meeting of the International Neuropsychological Society, Waikoloa, HI.Google Scholar
Rabin, L.A., Borgos, M.J., & Saykin, A.J. (2008). A survey of neuropsychologists' practices and perspectives regarding the assessment of judgment ability. Applied Neuropsychology, 15 (4), 264273.Google Scholar
Rabin, L.A., Borgos, M.J., Saykin, A.J., Root, M.D., Wishart, H.A., Flashman, L.A., . . . Santulli, R.B. (2005, February). Judgment in older adults with AD, MCI, and cognitive complaints: Development and preliminary psychometric evaluation of the Dartmouth–Rabin Judgment Questionnaire (DRJQ). Presented at the 33rd Annual Meeting of the International Neuropsychological Society, St. Louis, MO.Google Scholar
Rabin, L.A., Borgos, M.J., Saykin, A.J., Wishart, H.A., Crane, P.K., Nutter-Upham, K.E., & Flashman, L.A. (2007). Judgment in older adults: Development and psychometric evaluation of the test of practical judgment (TOP-J). Journal of Clinical and Experimental Neuropsychology, 29 (7), 752767.Google Scholar
Rabin, L.A., Saykin, A.J., West, J.D., Borgos, M.J., Wishart, H.A., Nutter-Upham, K.E., . . . Santulli, R.B. (2009). Judgment in older adults with normal cognition, cognitive complaints, MCI, and mild AD: Relation to regional frontal gray matter. Brain Imaging and Behavior, 3 (2), 212219.Google Scholar
Ravaud, J.F., Delcey, M., & Yelnik, A. (1999). Construct validity of the functional independence measure (FIM): Questioning the unidimensionality of the scale and the "value" of FIM scores. Scandinavian Journal of Rehabilitation Medicine, 31 (1), 3142.Google Scholar
Royall, D.R., Lauterbach, E.C., Kaufer, D., Malloy, P., Coburn, K.L., & Black, K.J. (2007). The cognitive correlates of functional status: A review from the Committee on Research of the American Neuropsychiatric Association. The Journal of Neuropsychiatry and Clinical Neurosciences, 19 (3), 249265.Google Scholar
Ruchinskas, R.A., Singer, H.K., & Repetz, N.K. (2000). Cognitive status and ambulation in geriatric rehabilitation: Walking without thinking?. Archives of Physical Medicine and Rehabilitation, 81 (9), 12241228.Google Scholar
Tolea, M.I., Morris, J.C., & Galvin, J.E. (2015). Longitudinal associations between physical and cognitive performance among community-dwelling older adults. Plos One, 10 (4), e0122878.Google Scholar
Tombaugh, T.N., & McIntyre, N.J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40 (9), 922935.Google Scholar
Uniform Data System for Medical Rehabilitation. (2012). The FIM instrument: Its background, structure, and usefulness. Retrieved from http://www.udsmr.org/Documents/The_FIM_Instrument_Background_Structure_and_Usefulness.pdf.Google Scholar
Woods, A.J., Mark, V.W., Pitts, A.C., & Mennemeier, M. (2011). Pervasive cognitive impairment in acute rehabilitation inpatients without brain injury. American Academy of Physical Medicine and Rehabilitation, 3 (5), 426432.Google Scholar
Woods, D.C., Patterson, M.B., & Whitehouse, P.J. (2000). Utility of the judgment questionnaire subtest of the neurobehavioral cognitive status examination in the evaluation of individuals with Alzheimer's disease. Clinical Gerontologist, 21 (4), 4966.Google Scholar
Zinn, S., Bosworth, H.B., Hoenig, H.M., & Swartzwelder, H.S. (2007). Executive function deficits in acute stroke. Archives of Physical Medicine and Rehabilitation, 88 (2), 173180.Google Scholar