Convergence of clinical staff ratings and research ratings to assess patients with schizophrenia in nursing homes

Objective: A large number of older patients with serious mental illnesses, including schizophrenia, now reside in nursing homes or similar residences, yet little is known about assessments, services, or outcomes for these patients. The Minimum Data Set (MDS) is a mandatory assessment instrument for nursing care facilities, and although it has been well studied in the general nursing home population, little is known about its validity in assessing schizophrenia, which was the purpose of this study. Methods: A group of 77 patients with schizophrenia had been recruited as part of a longitudinal study and were evaluated after their referral to nursing homes. Researchers compared ratings from the MDS with ratings of cognition and symptoms using instruments previously validated for the assessment of serious mental illness. Results: The cognitive subscale of the MDS (MDS-COG) was not strongly correlated with the Mini-Mental State Examination and was generally uncorrelated with performance on neuropsychological tasks. Symptoms were underreported on the MDS and were not significantly associated with researchers' ratings. Moreover, the ratings from the MDS, unlike the researchers' ratings, were not predictive of functional status, revealing poor criterion validity. Conclusions: These findings suggest that the MDS is not a suitable rating instrument to evaluate the symptoms and functional characteristics of older patients with schizophrenia. Future work will be required to develop instruments that would allow nursing home staff to recognize and report symptoms, cognitive impairments, and functional characteristics of these patients, which are important first steps for improving treatment services.