Objectives. Accurate clinical assessment of disease among the elderly is seriously compromised by the economic constraints imposed by the healthcare system. As a direct result of limited reimbursement, many clinicians rely on quickly administered metric instruments which do not accurately adjust for the high prevalence of physical disabilities. The elderly are the fastest growing segment of the population, and these constraints have led to high rates of misdiagnoses, resulting in improper patient care, increased healthcare costs, and premature death.

The discriminative ability of the Mini-Mental Status Examination (MMSE), Cambridge Cognitive Examination Motor Examination (CAMCOG_ME), and the Unified Parkinson's Disease Rating Scale (UPDRS) are evaluated. A memory intervention which accommodates the high prevalence of physical conditions with the goal of improving cognitive function is also evaluated.

Methods. Residents in an urban long-term care facility were studied. Subjects were recruited for multiple studies and depending on the protocol, were administered the MMSE, CAMCOG, Clinical Dementia Rating (CDR), and the UPDRS_ME. Medical records information was collected on all subjects.

Results. A 97% prevalence rate for motor deficits was observed, with 50% of subjects unable to answer individual questions on the MMSE as a result of non-cognitive related reasons and only 20% were able to be evaluated on all 27 UPDRS_ME items. Comparable discriminative ability was found using a 7-item subset of the UPDRS_ME and 5 out of 20 MMSE items. The CAMCOG improved sensitivity to isolate cognitive deficits in a number of domains. However, areas such as perception still need to be modified to provide greater discriminative ability. The memory intervention showed improvement across all subjects for multiple areas of cognition.

Conclusions. Changes in healthcare reimbursement have resulted in the continued use of quickly administered metric instruments with decreased discriminative ability. The prevalence of co-morbid conditions has resulted in a bias for these instruments to misdiagnose the elderly population, resulting in poor patient care, increased healthcare costs, and premature death. The identification of these problems is the first step in improving diagnostic accuracy and the success of any interventions with the growing elderly population, leading to improved patient care and decreased costs for healthcare.