Title : A graded care management strategy and its effectiveness analysis for elderly patients with cognitive impairment
Abstract:
Objective: To develop a tiered care management strategy for elderly patients with cognitive impairment and to evaluate its clinical effectiveness.
Methods: A randomized controlled trial design was employed. Eighty-four elderly patients with cognitive impairment from the geriatrics department of a grade III level a hospital in Henan province who met the inclusion criteria were selected and randomly assigned to an intervention group and a control group (42 patients each) using a coin toss. The control group received routine geriatric care, while the intervention group, in addition to routine care, was stratified into three levels — mild, moderate, and severe — based on the results of the Mini-Mental State Examination (MMSE), and each group received a differentiated, tiered care management strategy: The mild group focused primarily on cognitive training and behavioral guidance; the moderate group added assistance with Activities of Daily Living (ADL) and environmental safety interventions to this foundation; and the severe group further emphasized nutritional support, prevention of complications, and empowerment of family members. The intervention period lasted 8 weeks. Before and after the intervention, the Mini-Mental State Examination (MMSE), Activities of Daily Living (ADl) scale, Neuropsychiatric Inventory (NPI), and Zarbin Burden Index (ZBI) were used to assess patients cognitive function, functional ability, neuropsychiatric symptoms, and caregiver burden.
Results: After the intervention, the mild group showed the most significant improvement in cognitive function (p < 0.01); the moderate group demonstrated a marked increase in ADL scores (p < 0.05); and the severe group exhibited a significant decrease in NPI scores (p < 0.01). Psychiatric and behavioral symptoms were effectively controlled in all groups, and caregiver burden was significantly reduced compared to pre-intervention levels (p < 0.05). Stratified comparisons showed that the tiered care strategy was more effective than the traditional uniform care model in maintaining cognitive function, preserving activities of daily living, and managing psychiatric symptoms (p < 0.05).
Conclusion: A tiered care management strategy based on the severity of cognitive impairment can effectively slow cognitive decline in patients, improve their ability to perform activities of daily living, reduce psychiatric and behavioral abnormalities, and simultaneously alleviate the burden on caregivers. This strategy embodies the principles of precision and individualized care and is suitable for promotion and application in the clinical practice of caring for older adults with cognitive impairment.
Keywords: Cognitive Impairment, Elderly Patients, Tiered Care
