Abstract
Neuropsychological assessment has traditionally been used to aid in the diagnosis of diseases of the central nervous system. Within a rehabilitation context however, neuropsychological assessment is playing an increasing role in delineating patients' cognitive strengths and weaknesses in order to address applied functional issues. The majority of related research in rehabilitation neuropsychology has been conducted with a young adult population, typically patients with acquired brain injuries. Rehabilitation of the elderly, however, is a quickly growing component of professional rehabilitation services. Given the current aging trend of the population, demand for such services is expected to parallel this growth pattern. At this time, relatively little is known empirically about geriatric rehabilitation programs and the role of neuropsychological assessment for geriatric rehabilitation applications. Within a context of Continuous Quality Improvement in clinical practice, the present study investigated patterns of neuropsychology referrals on a 36-bed geriatric rehabilitation unit, with frail and comorbidly complex patients. The prevalence of referrals made to neuropsychology and the specific referral questions posed are outlined, subsequent to tabulation over a 12-month period. The study further examined the test selection utilized and the extent to which recommendations made by neuropsychologists covaried with test results. Findings revealed that referrals involved 1 or more of 3 issues to be addressed. The most frequent question was related to the patient's competency to live independently. Results further revealed that varying recommendations regarding the level-of-care required were associated with significant differences on some test scores, but not others. Score patterns and recommendations made for each referral question are outlined. The discussion addresses the need for further research aimed at identifying predictors of instrumental daily living skills in seniors, and related functional cutoff scores on psychometric tests, in order to facilitate evidence-based practices in geriatric neuropsychology.