Mental Status

I knocked at the door. 

“Come in!”  Ms. Caldwell exclaimed, mustering all of her strength to greet me. 

“May I visit with you?”  

Ms. Caldwell had been admitted to the nursing home a couple of days ago.  After being hospitalized for a hip fracture, the surgeon had explained she needed rehabilitation therapy before returning home. 

“Yes. Have a seat.”  Her voice sounded as weak as it did the day she first arrived.  She was lying in bed.  Her slender arms moved slowly, trying to adjust the pillows under her head. 

“Can I help you?”  I drew close to her bed, attempting to reach the pillows.

“No, I’ve got it.”  Her words tumbled with effort from her mouth, but I understood. I  found myself almost staring at her when I spotted her bright eyes.  I had not noticed she had beautiful blue eyes, bright in contrast to her light brown curly hair.  

Ms. Caldwell’s eyes were curiously focused on the clipboard I was resting on my left arm, poised to write my social services assessment paperwork on. 

As a social worker, I conduct a psychosocial assessment on each one of my new residents.  Part of the assessment has to do with what we call ‘the resident's mental status’. We want to know about the resident’s current state of mind, for instance, if he/she knows who he/she is (orientation as to person), where he/she is (orientation as to place), and if he/she knows the date (orientation as to time).  

Also, we ask questions to explore their memory—both short and long-term. This evaluation is required in each skilled nursing facility.  And it is a component of a more extensive—comprehensive assessment, which will be crucial for the inter-disciplinary team to determine the level of care, and the type of interventions a resident may need. 

I explained to Ms. Caldwell the reason for my visit and about the questions I was going to ask. 

“Okay.”  She answered, her voice in disbelief. 

On my first conversation with Ms. Caldwell upon arrival to the facility, I noticed she paused quite often, and at times appeared that she had to think hard before articulating an answering.  My first observation may have not be an accurate reflection of her mental status.  It’s quite common to see elderly patients confused after surgery, and then a week later, be back to their normal acuity of mind.  However, sometimes residents may have an underlying cognitive deficit and the confusion may be just part of their baseline mental status. 

At this point, I was not sure about Ms. Caldwell. 

I asked her the first question. Ms. Caldwell glared at me.  Sometimes residents may dislike this type of visits, the visit where they are asked 'tricky questions' and their embarrassment and frustration at not knowing the answer or how to respond is exposed.  As gentle as I always try to be, the residents know they are being tested for their cognitive status. 

I pondered what Ms. Caldwell’s reaction would be. 

I felt a bit of excitement when she answered appropriately.  I continued asking questions, and she continued giving me accurate answers.  A pleasant feeling filled me when we were finished with the last question. 

“Very good!” I said, flashing a grin. 

She glared at me again. Then her lips curled up, drawing an endearing grin.  And her words came out with unexpected strength, and delightful irony.

“I hit my hip, not my head.”