THE DEVELOPMENT OF A DEMENTIA SCREENING GUIDELINE FOR OLDER ADULTS WITH HYPERTENSION AT SRISOMDET HOSPITAL, ROI ET PROVINCE

Abstract

Purposes: To investigate the situation of dementia, develop a dementia screening guideline, and evaluate the implementation of the dementia screening guideline among older adults with hypertension at Sisomdet Hospital, Roi Et Province, Thailand.

Study design: This research and development (R&D) study was conducted by applying the research and development framework of Borg and Gall. The study consisted of three phases and 10 steps: Phase 1, situational assessment and guideline development; Phase 2, pilot implementation and refinement of the guideline; and Phase 3, implementation in the real-world clinical setting, evaluation, and development of the final guideline.

Materials and Methods: Participants were purposively selected and comprised 10 healthcare personnel involved in the care of older adults and 40 older adults with hypertension. The research instruments included a dementia screening guideline, the Barthel Activities of Daily Living (ADL) Index, the Thai Mental State Examination (TMSE), a knowledge questionnaire, and a satisfaction questionnaire regarding the use of the guideline. Content validity was assessed by a panel of experts, and the reliability of the instruments was examined. The knowledge questionnaire had a Kuder–Richardson Formula 20 (KR-20) coefficient of 0.71, while the satisfaction questionnaire had a Cronbach’s alpha coefficient of 0.78. Data were analyzed using frequency, percentage, mean, standard deviation, and a paired-samples t-test.

Main findings: Among the 40 older adults with hypertension, the mean age was 72.25 years (SD. = 6.12). The mean Barthel ADL Index score was 19.20 (SD. = 2.02), and the mean TMSE score was 24.03 (SD. = 4.78). Ten participants (25.00%) had TMSE scores of ≤23 points, indicating the need for further cognitive assessment. The developed guideline consisted of six components: (1) preparation before screening; (2) history taking and assessment of relevant factors; (3) cognitive screening using the TMSE; (4) provision of advice to promote brain health; (5) establishment of referral criteria and referral pathways; and (6) systematic documentation and follow-up. After implementation of the guideline, healthcare personnel had a higher mean knowledge score of 14.50 (SD. = 0.71), compared with 12.60 (SD. = 1.78) before implementation (p = .002). Overall satisfaction with the guideline was rated at the highest level.

Conclusion and recommendations: The developed dementia screening guideline provides clear and comprehensive procedures covering cognitive screening, brain health promotion, referral, and follow-up. The guideline appears feasible for implementation in hypertension clinics. Preliminary evaluation indicated that its implementation was associated with improved knowledge among healthcare personnel and a high level of overall satisfaction. The guideline should be integrated into routine healthcare services, accompanied by ongoing capacity building for healthcare personnel and continuous development of documentation, follow-up, and referral systems. Further studies should evaluate its effectiveness in larger and multisite samples and examine its long-term outcomes.