Journal of Gerontological Nursing
Vol. 31 No. 9 September 2005
By Roy H. Olsson, PhD, CTRS; Suzanne Wambold, PhD, RN, RDCS; Barbara Brock; Diana Waugh, RN, BSN; Heather Sprague, MA, CTRS
ABSTRACT
Risk of falling is a major concern of long-term care facilities with residents diagnosed with dementia. Use of a brief cognitive assessment focusing on visual spatial abilities could be one strategy in the prevention of falls in residents with dementia. The objective of this study was to determine if a clock test could predict a risk of falls in residents diagnosed with dementia. Three hundred sixty-four individuals with dementia participated (92 men and 272 women; ages 37 to 100, mean 80.5 years, median 83 years). Each participant was given the Reality Comprehension Clock Test (RCCT) three times, and Mini Mental-Status Examination (MMSE) two times to determine criterion-related validity, test.retest reliability, internal consistency; and to set and evaluate a risk of falls score based on the Visual Spatial Score (VSS) component produced by the RCCT. Significant findings included .72 (p <.01) correlation between the RCCT and the MMSE, .90 (p < .01) correlation between the first administration of the RCCT and the second administration of the RCCT; an alpha of .95 (p < .001) and an F value of 7.6 (p < .001) producing a risk of falls initial VSS of 5 or lower compared to 9 or greater. Chi-square of 6.3 for 30 days (p < .01), 11.08 for 60 days (p < .01) and 13.3 for 90 days (p < .01) indicated a significant difference in the number of falls occurring in the high risk group (VSS of 5 or lower) compared to the low/ no risk group (VSS of 9 or higher). A risk factor analysis suggested that residents in the higher risk group were three times more likely to have fallen than residents in the low risk group. Knowing a resident's visual spatial ability offers health care providers an opportunity to implement a resident-specific intervention that addresses their cognitive ability and visual spatial deficit that may reduce the resident's risk of falling.
ABOUT THE AUTHORS
Dr. Olsson is Dean, School of Professional Studies, The State University of New York at Cortland, Cortland, New York. Dr. Wambold is Associate Professor and Chair, Department of Health Professions, University of Toledo, Toledo, Ohio. Ms. Brock is RCCT Expert and President, Communication Art, Inc., Toledo, Ohio. Ms. Waugh is National and State Health Educator, Waugh Consulting, Waterville, Ohio. Ms. Sprague is Independent Living Counselor, PARI Independent Living Center, Pawtucket, Rhode Island.
Supported by a grant (582000) from HCR Manorcare. Barbara Brock, founder of Communication Art, Inc. and her colleagues assisted in delivery of the RCCT
(www.clocktestrcct.com).
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity.
Address correspondence to Barbara Brock, Communication Art, Inc., 2330 Ragan Woods, Toledo, OH 43614.
