How Senior Living Can Help Identify Signs of Cognitive Decline and Support Healthy Living

About Tori Thurmond

Tori Thurmond combines her creative writing background with her marketing experience in her role as the Content Specialist at Brookdale. When she's not writing, she's probably spending time with her two cats or knitting.

resident talking to Brookdale care partner

Warning signs of decline in your older adult patients can be difficult to flag when you only see them once or twice a year. Even though families often notice decline after a bigger event like a fall or other medical event, cognitive decline is often insidious, developing gradually over time.

Many early signs of cognitive decline are subtle and can be near-impossible to detect during a time-limited encounter or snapshot assessment, like a routine doctor’s visit. Senior living can help you determine if certain symptoms are part of an ongoing trend with your patient or simply an isolated moment. Senior living can contribute to early detection by identifying and reporting to healthcare providers subtle changes in activities of daily living that might otherwise go unnoticed. Senior living can also help preserve cognitive functioning and well-being by providing supportive care within an environment that enables residents to sustain brain-healthy lifestyle habits.

How Senior Living Can Help Identify Early Signs of Decline

Decline is such a gradual process in many cases that early changes in behavior may be too subtle to notice at first. Brookdale Gerontologist Christy Philips, Ph.D., notes, “Really subtle changes associated with Alzheimer’s disease can start manifesting in how you navigate your everyday activities that are more cognitively complex as early as mid-life. For example, changes in gait speed or other aspects of gait such as symmetry or smoothness may appear up to 20 years before a diagnosis. But they are not changes you’d necessarily perceive in everyday life.” Eventually, these small preclinical changes may progress to mild cognitive impairment or dementia, in which symptoms manifest clinically. The earlier symptoms are detected the better because early intervention provides patients with the best opportunity to either help prevent or delay the onset of a dementia or slow disease progression if a diagnosis is made.

Jill Ladaa, Brookdale’s Alzheimer’s and Dementia Gerontologist states that dementia involves a progressive decline in cognitive functioning that becomes significant enough to interfere with a person’s ability to carry out everyday activities and maintain independence. As a physician, you may not always have as much insight as desired when it comes to your patient’s daily routines and whether certain tasks are falling through the cracks.

Senior living can play an important role in pattern recognition for residents, provide the resident’s family with observations that could be helpful to you during their next doctor visit and help support overall healthy living to address early signs of cognitive decline.

When a person moves into a senior living community, most likely, their world has been shrinking due to mobility challenges, cognitive decline and other factors that may make it difficult for these older adults to interact with the world around them as much as they used to. By moving into senior living, their community grows and their overall quality of life can improve. Ladaa states, “At home, these individuals were surviving, but in a senior living community, they can thrive.”

The U.S. POINTER clinical trial conducted by the Alzheimer’s Association® supports the idea that healthy behavior positively impacts brain health. Factors such as physical activity, improved nutrition, cognitive and social challenge and health monitoring can help preserve or improve cognitive function among older adults at risk of cognitive decline. With senior living, residents benefit from a built environment intentionally designed to support well-being and a collaborative care team that partners with them to help promote and sustain these different facets of healthy living.

Additionally, daily interactions with residents place senior living care teams in a unique position to notice early functional changes that signal decline and share their observations with the resident’s family or primary care physician. When someone interacts with a person regularly and for an extended period of time, they may notice the missteps or out-of-the-norm behaviors. Did your patient briefly forget the name of an old acquaintance, or have they been forgetting things they normally have no trouble recalling? Is your patient starting to have trouble following or joining conversations or struggling with complex, multi-step tasks such as managing medications?

Self-reporting or even reporting from family members isn’t always reliable. Because the process can be so gradual, it may be difficult to tell how much a person is actually declining. Senior living teams can act as a reliable source to report on symptoms that may indicate decline is occurring.

In assisted living or memory care, residents interact with staff daily who will know your patient’s typical behaviors. A senior living team can help keep an eye out for physical and cognitive changes that could indicate that your patient needs to come in for a visit.

How Healthcare Professionals Can Help

Even with the best clinical oversight, infrequent encounters make it challenging to detect early shifts in cognition. Several underutilized screening instruments can be incorporated into your patient’s Medicare Annual Wellness Visit (AWV), or at any other visit in which a patient reports cognitive complaints or in which you suspect possible cognitive decline. These instruments allow for a brief and objective assessment of cognitive function to help identify those in need of a more comprehensive evaluation. A few examples include:

Montreal Cognitive Assessment (The MoCA Test): The MoCA Test is a tool that was developed to help detect mild cognitive impairment (MCI). There are several versions of MoCA that are available, including a digital option that is free for healthcare professionals and paper options. Any clinician, healthcare professional, researcher or worker who has successfully completed the official MoCA training and certification may administer this test. Training only takes around an hour, and MoCA has a 90% sensitivity rating for detecting MCI. MoCA’s administration time is approximately 10 minutes.
The Mini-Mental State Exam (MMSE): The MMSE is a test used to measure cognitive function. While individuals can download a copy of the MMSE to perform at home, the test is best administered by a trained healthcare professional in an office environment. Administration time for the MMSE is approximately 5-10 minutes, but it is considered less sensitive to MCI than MoCA and requires permission to use the test.
The Mini-Cog: The Mini-Cog is a 3-minute screening test developed to detect clinically significant cognitive impairment in primary care. This test requires minimal training and no clinical background in the cognitive disorders field and can be administered and scored by trained healthcare workers, medical assistants, nurses, social workers, physicians and other providers.

By utilizing these tools, you may be able to help your patients recognize early signs of cognitive decline to help promote early intervention. For patients with cognitive concerns or a confirmed decline, consider referring them to a senior living community where they can gain a whole team to help support their overall health and well-being.

How Brookdale Can Help

At Brookdale, we are committed to helping our residents and their families coordinate care with HCPs. Instead of waiting for something big to happen, like a fall, for instance, we aim to work alongside you and help support improved health outcomes for the patients you serve.

Our Brookdale HealthPlus® care coordination program, available at select Brookdale communities, works to help improve residents’ quality of life and help prevent avoidable emergency room visits or hospitalization in partnership with their family healthcare providers. Each Brookdale HealthPlus® community has a dedicated RN Care Manager who proactively helps residents manage their health every day and serves as a partner for other healthcare professionals. They’re an advocate for residents to help manage care transitions, including coordinating communication between providers, reconciling medications and scheduling follow-up visits with physicians.

Brookdale also offers The Embrace™ Family Partnership Program in our Brookdale Clare Bridge® communities. This program offers education, resources and support for caregivers and families, as they navigate a dementia diagnosis. Each Embrace Family Partnership Event provides an opportunity to learn about Alzheimer’s and related dementias, helpful tips and tools and a space to develop connections with other caregivers navigating a diagnosis with their loved one. These monthly events are also offered to the public.

The difference can be remarkable when your patient comes to live at Brookdale. We’re ready to collaborate and find the ideal community that helps meet your patient’s needs. You can feel confident that your patient will receive support and care to help them lead a healthier and happier life.

Learn More

Reach out to find out more about how Brookdale partners with HCPs to help support the well-being of our residents. Visit our website to find a community near you.

_{The above content is shared for educational and informational purposes only. References to any products or services, or links to any third-party websites, do not constitute an endorsement, sponsorship, or recommendation of such products, services, or third parties by Brookdale or its affiliates.}

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