Table 6Description of participant cognitive function: U.S. cross-sectional and longitudinal peer-reviewed studies

StudyMeasure of Cognitive FunctionHCBS/ALNHSignificanceSummary
aBeattie et al., 200534Mean MMSE score; range 0–24, with lower scores indicating more impairmentAL: 8.40 (SD 7.06)7.56 (SD 7.10)Not significantOn average, AL residents did not differ significantly from NH residents in cognitive function scores (study focused on samples with dementia)
aEdelman et al., 200540(All participants had MMSE score of 10 or higher)
Mean MMSE score; range 0–30, with lower scores indicating more impairment
AL: 11.1 (SD 6.8)7.9 (SD 6.8)p<0.01On average, AL residents had higher cognitive function (study focused on samples with dementia)
Pruchno and Rose, 200054Mean MMSE score; range 0–30, with lower score indicating more impairmentAL: 23.57 (SD 4.25)23.09 (SD 4.06)Not significantOn average, AL residents did not differ significantly from NH residents in cognitive function
Lee et al., 200146MDS-COGS; range 0–9, with higher scores indicating more impairmentScores were not specifiedScores were not specifiedMean score of HCBS participants was significantly lower than NH participants (p<0.05)On average, HCBS recipients had higher cognitive function
Collaborative Studies of Long-Term Care subsample
aSloane et al., 200562
(All participants had diagnosis of dementia)
Mean MDS-COGS score; range 0–10, with higher scores indicating more impairment
AL: 5.3 (SD 2.4)5.7 (SD 2.3)p=0.005On average, AL residents had higher cognitive function (study focused on samples with dementia)
Borrayo et al., 200236Mean cognitive impairment; range 0–3, with higher scores indicating more severe impairment

Alzheimer's disease or other dementia (percentage)
HCBS: 1.72 (SD 1.23), 18%
AL: 1.60 (SD 1.12), 42%
1.42 (SD 1.05), 56%NROn average HCBS recipients and AL residents had more cognitive impairment; HCBS and AL groups had fewer individuals with Alzheimer's disease or other dementia
Gaugler, 200643Mean SPMSQ score; range 0–10, with higher scores indicating more impairmentHCBS: 3.02 (SD 2.67)
AL: 2.30 (SD 2.20)
3.20 (SD 2.46)Not significantOn average, HCBS recipients and AL residents were not significantly different from NH residents in cognitive function
aLeon and Moyer, 199947(All participants met criteria for probable Alzheimer's disease)
Mean CDRS score; range 0.5–6, with higher scores indicating more severe dementia
AL: 2.16 (SD 0.97)2.72 (SD 0.97)p<0.001On average, AL residents had less severe dementia (study focused on samples with dementia)
Oregon Assisted Living Gaugler and Kane, 200544Mean MSQ score; range 0–10, with lower scores indicating more impairmentAL: 7.07 (SD 2.30)6.46 (SD 2.18)p<0.001On average, AL residents had higher cognitive function
aDementia Care Project
Port et al., 200553
(All participants had diagnosis of dementia)
Classified with mild, moderate, severe, or very severe dementia based on MMSE or MDS-COGS (percentage)
AL: 13.3% mild, 28.8% moderate, 23.8% severe, 29.2% very severe8.0% mild, 13.3% moderate, 22.1% severe, 56.6% very severep=0.003AL group had fewer individuals with very severe dementia (study focused on samples with dementia)
Kansas Medicaid Studies Shireman and Rigler, 200460Diagnosis of Alzheimer's disease or dementia (percentage)HCBS: 6.1%34.6%p<0.01HCBS group had fewer individuals with a diagnosis of Alzheimer's disease or dementia
Reinardy and Kane, 199955Dementia diagnosis (percentage)HCBS: 15%20%Not significantHCBS recipients did not differ significantly from NH residents in the number of individuals diagnosed with dementia
Collaborative Studies of Long-Term Care subsample
Sloane et al., 200363
Moderate or advanced dementia at study enrollment (percentage)AL: 38.6%67.2%p=0.001AL group had fewer individuals with moderate or advanced dementia at study enrollment
Wieland et al., 201064Diagnosis of dementia (percentage)HCBS: 18.0%
PACE: 80.9%
50.2%p<0.001HCBS group had fewer individuals than NH group with a diagnosis of dementia; PACE group had more individuals than NH group with a diagnosis of dementia
aMitchell et al., 200452(All persons in sample had diagnosis of dementia and CPS of 5 or 6 at admission)
CPS 6 versus 5 (percentage), with 6 indicating more cognitive impairment
HCBS: 34.6%57.1%p<0.001HCBS group had fewer individuals with the highest cognitive impairment score (study focused on samples with dementia)
ASPE private LTC insurance cohort
Doty et al., 201039
Cognitive impairment (percentage)HCBS: 28%
AL: 63%
64%NRHCBS group had fewer individuals than the NH group with cognitive impairment; AL group had similar number of individuals as NH group with cognitive impairment
Mehdizadeh, 200251Cognitively impaired (percentage)HCBS: 16%49%NRHCBS group had fewer individuals with cognitive impairment
Collaborative Studies of Long-Term Care subsample
Zimmerman et al., 200367
Cognitive impairment indicated by diagnosis of dementia, MMSE score, or information on MDS (percentage)AL(a): 42%
AL(b): 35%
AL(c): 23%
51%NRAL groups had fewer individuals with cognitive impairment

AL = Assisted Living; ASPE = Assistant Secretary for Planning and Evaluation; CDRS = Clinical Dementia Rating Score; CPS = Cognitive Performance Score; HCBS = Home and Community-Based Services; LTC = Long Term Care; MDS-COGS = Minimum Data Set Cognition Scale; MMSE = Mini-mental State Exam; MSQ = Mental Status Questionnaire; NH = Nursing Home; NR = Not Reported PACE = Program of All-Inclusive Care; SD = Standard Deviation; SPMSQ = Short Portable Mental Status Questionnaire

Note: Table rows ordered by similar measures of cognitive function.

a

Study focused on samples with dementia.

Study focused on samples with dementia.

From: Results

Cover of Long-Term Care for Older Adults
Long-Term Care for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care [Internet].
Comparative Effectiveness Reviews, No. 81.
Wysocki A, Butler M, Kane RL, et al.

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