Section C: Understanding Cognitive State
Decision-Making Ability, Memory, and Cognitive Changes in Daily Life
Dear colleagues, dear social service professionals,
We are continuing our journey through the sections of the interRAI HCSuisse manual.
This month, we’ll take a closer look at Section C: cognitive abilities, a fundamental area for understanding a person’s level of independence and planning truly tailored care.
Assessing cognitive abilities means more than simply checking whether the person is oriented in time and space. It means observing how they make decisions, remember useful information, and manage their daily life in practical terms.
Decision-Making Abilities in Daily Life
The assessment should focus on how the person actually makes the decisions necessary to organize their day.
Aspects to observe include:
choosing what to wear;
organizing meals;
the appropriate use of living spaces;
the ability to ask for help when necessary;
recognizing one’s own limitations;
managing daily activities and commitments.
It is important to assess actual performance rather than what the person is theoretically capable of doing.
A diagnosis of dementia, on its own, does not automatically determine the code. Similarly, an apparently coherent conversation does not necessarily prove that the person is capable of making independent decisions in daily life.
Memory is not a single ability
Section C takes into account different forms of memory.
Short-term memory refers to the ability to recall recent information or events. Situational memory, on the other hand, enables a person to recognize familiar people, places, and circumstances, and to behave appropriately in their environment.
The assessment should not be based on a single question. It is necessary to gather information through interviews, observations, and discussions with those who interact with the person on a daily basis.
Pay attention to fluctuations
Cognitive abilities can vary throughout the day. A person may appear lucid at certain times and exhibit significant difficulties at others.
This is why Section C also takes into account:
difficulties with concentration;
disorganized thinking or speech;
fluctuations in cognitive abilities throughout the day;
any acute changes from usual functioning.
A sudden change should not automatically be interpreted as normal cognitive decline. It may indicate an acute condition requiring a thorough clinical evaluation, in accordance with the organization’s procedures.
Where do we see the results?
Does the information collected contribute to the development of the Cognitive Performance Scales (CPS 1 and CPS 2)? CPS 1 and CPS 2, which are used to represent and track an individual’s cognitive abilities over time.
These scales help detect potential changes and assess whether care goals and interventions need to be updated. However, their results should not be considered in isolation.
The situation must be interpreted as a whole, by establishing connections between:
the items in Section C;
the other sections of the assessment;
the scales generated by the system;
the CAPs;
clinical observation.
The CAP related to cognitive decline facilitates the transition from assessment to care planning by helping to identify potential areas for prevention, maintenance, or intervention.
A Common Mistake
During the interview, a person answers questions correctly and appears oriented. In daily life, however, they are no longer able to organize their meals, forget to take their medications, and need a loved one to make important decisions for them.
Classifying the person as fully independent based solely on the impression gained during the interview would not reflect their actual functioning.
The question to ask is always the following: How does she actually handle day-to-day decisions?
What sources should be used?
To obtain a reliable picture, it is helpful to combine:
a direct interview with the person;
observation in their environment;
information provided by family members or significant others;
available clinical documentation;
consultation with those who regularly provide care for them.
The goal is not to make a diagnosis, but to accurately describe the cognitive functioning observed during the reference period.
Would you like to learn more about using interRAI HCSuisse?
In our Italian-language training sessions, Esther Chapman guides healthcare professionals through the correct collection of information, the coding and interpretation of scales and CAPs, all the way through to care planning.
Visit our website for the updated schedule and information on upcoming interRAI HC training sessions.
Observing a person’s actual functioning allows us to transform the assessment into more robust and personalized care.
Swiss Chapman Consulting SAGL
