When non-medical home care agencies send aides clients’ homes, the agencies often talk about the benefits of cognitive exercises and social contact. In addition to assistance with cleaning, organization, nutrition, medication adherence, and grooming, home-visiting aides provide socialization and may even try to engage clients in hobbies and games specifically chosen for their capacity to improve cognition. It sounds good, but does this approach produce results? The research of Susan L Hughes, DSW, Northwestern University, says “yes.”¹

The Impact of Long-Term Home Care on Cognitive Function

Five hospitals in the Chicago area provided non-medical home care to 157 seniors, and the research team observed the effects over four years. The researchers compared the treatment group to 156 seniors who were not enrolled in the long-term home care program. Participants had to be at least 60. The average age was 81. All care recipients were homebound and medically underserved. At both nine months and four years, the seniors receiving long-term home care scored significantly better in cognitive function questions.

What is the SPMSQ (Short Portable Mental Status Questionnaire)?

Researchers used the SPMSQ, a validated tool of cognitive function.² This simple test consists of ten questions:

1. What are the date, month, and year?
2. What is the day of the week?
3. What is the name of this place?
4. What is your phone number?
5. How old are you?
6. When were you born?
7. Who is the current president?
8. Who was the president before him?
9. What was your mother’s maiden name?
10. Can you count backward from 20 by 3’s?

Examiners score participants based on the number of errors made.

• Normal mental functioning: 0-2 errors
• Mild cognitive impairment: 3-4 errors
• Moderate cognitive impairment: 5-7 errors
• Severe cognitive impairment: 8 or more errors

The scoring is adjusted for education level. If the patient has grade school education or less, one more error is allowed in each category. On the other hand, if the patient has greater than a high school education, one less error is allowed in each category. For instance, a patient with a college degree would be scored as having mild cognitive impairment with two errors.

How Does Home Care Improve Cognition?

In this study, the care plan for each senior was individualized, so there was no telling exactly why the seniors receiving home care faired so well in cognitive function. One theory offered by the researchers is that greater socialization helped. Having aides visit at certain times and on certain days gave the seniors greater incentive to track the days and dates. Beyond that, the research surveys showed that seniors receiving long-term home care had greater contact with friends, relatives, and others.

Furthermore, aide services tend to give clients greater opportunities to enjoy better nutrition and engage in more activities with a greater sense of safety. Improved exercise and nutrition is shown to reverse cognitive impairment.

References

1. Hughes SL, Conrad K, Manheim LM, Edelman PL. Impact of long-term home care on mortality, functional status, and unmet needs. Health Services Research. 1988 Jun;23(2):269.
2. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society. 1975 Oct;23(10):433-41.