Hospitalization of the older adult may uncover mental changes that had gone unnoticed. Executive function is a set of abilities that includes flexible thinking, idea formation and self-monitoring. Assessing executive function can help determine a patient’s ability to handle healthcare decisions and discharge planning. When there are problems with executive function, the older adult may have trouble with normal activities (for example, shopping, driving and medication management) even though memory problems are mild.
Screening for executive dysfunction is intended for older adults who may not be exhibiting mental problems and where other tools may not pick up mental changes. Screening for executive dysfunction consists of three tests:
Royall’s CLOX Clock Drawing: Patients must draw a clock set at 1:45 and copy a clock with all the numbers in place set at 1:45. Mistakes with the clock may indicate mental impairment. Individuals with only executive dysfunction make mistakes with the first clock only; mistakes with both clocks indicate wider problems.
Controlled Oral Word Association Test: The older adult must fill in categories with words of at least three letters beginning with F, A and S. Patients with no metal problems can fill in at least ten words in one minute.
Trail Making Test – The Oral Version: Individuals must count from 1 to 25 and recite the alphabet. The patient is then asked to pair the number with the corresponding letter from the alphabet, for example: “1-A, 2-B, 3-C.” More than two errors out of 13 indicate metal problems.