Mentation
The Institute for Healthcare Improvement along with the John A Hartford Foundation, American Hospital Association, and the Catholic Health Association of the United States developed a framework for Age Friendly Health Systems. You can see a brief overview of this under the “4Ms” on the Basics page.
Today we’ll dive into the second of the four, “Mentation.” Mentation is a confusing term, but to make it more understandable, it refers to our cognitive and emotional health. Many people have an awareness, if not personal experience, of an older adult or loved one who experiences cognitive decline. Dementia is an umbrella term to describe this cognitive decline when it affects our day to day activities, but there are normal cognitive changes that occur as we age. There are many types of dementia, but the term itself is almost synonymous with Alzheimer’s Disease. To clarify this a little, Alzheimer’s accounts for 60-70% of the persons with dementia worldwide, but is not the sole cause of dementia.
Regarding the 4M Framework, in geriatrics we try to identify cognitive impairment and dementia early as to help the person and their family (or other decision-makers) navigate the health system and to slow the cognitive decline as much as possible. Due to the nature of dementia there is no cure and the tools we have are, at best, mediocre. It is vital for all persons diagnosed with dementia and caregivers to become intimately aware of “What Matters” to ensure proper and humanistic care is given to the patient, especially as the disease progresses. To clarify- there is a difference between cognitive impairment and dementia. Dementia specifically causes changes in a person’s ability to perform normal routine tasks that they used to be able to do without a second thought. This can range from balancing a checkbook to getting dressed. Cognitive impairment are changes that we notice in memory, but have no effect on our day to day life.
Another aspect of “Mentation” is our emotional health. Depression is common as we age; our bodies slow down, chronic illness takes an impact, and many of our friends die or otherwise leave our life. Around 10-15% of older adults exhibit depression, and depression takes its toll in many ways. Participating in our daily routines becomes more onerous and thinking becomes more challenging. Identifying and treating depression is critical to healthy aging as adults over the age of 85 have the second highest rate of suicide completion. Talking about mental health with anyone can be challenging, and we medical professionals need to assist in relieving that burden to achieve whole-person care.
Key Points:
Mentation refers to cognitive and emotional health
Healthy aging ensures protecting cognition and identifying declines as early as possible
Depression is a significant medical concern in the older adult and staying emotionally healthy is important to aging well
