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During a 2018 meeting of Dementia Friendly Southern Nevada Urban (DFSNU) in Las Vegas, stakeholders discussed ways of reaching into the community to perform basic memory screenings. All agreed it was a great idea and an important step in early detection.
The problem was a common one. Too many older adults at risk of dementia lived in underserved communities or had difficulties accessing a clinician.
Attending the meeting was Susan Farris, a program manager in the Education Department at the Cleveland Clinic Lou Ruvo Center for Brain Health. She and her colleagues knew that if patients couldn’t get to the doctor’s office, healthcare professionals would have to go where the patients were.
Farris found two other DFSNU members — both professors from a nearby nursing school — at the monthly meeting, pulled them aside, and asked them a question.
“Would you like us to train your nursing students to do basic cognitive screenings?” she asked. The duo, from the College of Southern Nevada, responded with an enthusiastic “Yes.”
And so began a fruitful collaboration that eventually welcomed a second nursing school — the University of Nevada, Las Vegas — that has sent nursing students to conduct memory screenings throughout southern Nevada, typically inside senior centers and faith-based communities.
Farris says the basic screenings are intended to offer general indicators like that at a health fair — not make a diagnosis. Based on the results, an onsite professional counselor is available at each event, with additional information from organizations specializing in aging services and dementia, including comprehensive cognitive assessment.
“The goal of this is to bring education and awareness and start a conversation,” says Farris, who oversees the clinic’s student and trainee education. “A lot of people have never had any sort of screening for their cognition.”
With the collaboration between DFSNU, the Cleveland Clinic and the two nursing schools, the screenings are proving an effective way of reaching out to older adults with limited access to healthcare. In 2018-2019, nurses at 10 events screened nearly 400 people.
The process is a simple one.
First, the nursing students are trained by Cleveland Clinic staff to use the Brief Alzheimer Screen (BAS), a tool developed by the Alzheimer’s Foundation of America. It includes a series of basic questions that include memorizing and repeating three words — “apple, table, penny” — spelling “world” backwards, and naming as many animals as possible in 30 seconds.
After the screening, scores are assessed onsite by Cleveland Clinic staff — typically Farris and two others. For those with questions who request a consultation — which happens for those scoring both low and high — they can meet immediately with a Cleveland Clinic faculty member for post-screening counseling. (Scores of 24 and above are considered “normal,” while scores of 23 and under suggest further testing from a health professional.)
Afterwards, volunteers from DFSNU are onsite to answer additional questions: the Cleveland Clinic’s Healthy Brains Initiative offers information on ways to optimize brain health; the local chapter of the Alzheimer’s Association answers questions about the disease and outlines its programs to support people living with dementia and their care partners; and Nevada Senior Services, which offers details on a wide array of services including housing, transportation and respite care.
Farris emphasizes that organizers want to make sure any concerns are addressed immediately and that all necessary referrals can be made.
“We didn’t want anyone to score below 24 and just leave, or for anyone, regardless of their score, to leave without having their questions answered” she says. Instead, organizers hope citizens will be encouraged to seek further information: “You know, it might be good for me to get tested.”
So far, the highest turnout has been at a Catholic church immediately following mass. A total of 83 parishioners were screened by 16 nursing students.
While initial funding for the screenings has now ended, Farris says the screenings will continue nevertheless because of continued need.
“We know that not everyone can come to us, so our goal is to get out in the community,” she says. “We really want to get out there in locations that are underrepresented or underserved.” And through the power of collaboration, this important service will continue.