Graduation Year


Document Type




Degree Granting Department

Public Health

Major Professor

Elizabeth Gulitz, Ph.D.

Co-Major Professor

James Mortimer, Ph.D.


Age associated cognitive decline, Cognition and rehabilitation outcomes, Cognitive assessment, Geriatric rehabilitation, Occupational therapy


Despite considerable debate surrounding an age associated cognitive decline in non-demented elders, recent studies indicate that changes attributable to normal aging affect cognitive processes and fluid abilities. Additionally, studies indicate that factors such as physical illness, depression, neurological damage, medication side effects, drug interactions, and the effects of surgery and anesthesia may also cause varying degrees of cognitive impairment. Impairment of cognitive function is known to affect treatment and rehabilitation outcomes for older persons, and increase their likelihood of institutionalization. Although proper screening and identification of cognitive deficits in geriatric patients are crucial in developing treatment plans, there is evidence in the medical and nursing literature that cognitive decline in older non-demented patients is often not identified.

Proper screening in this case, refers not only to whether or not clinicians engage in assessment behavior, but that they adhere to evidence-based practices and utilize standardized instruments which can identify the type, extent, and implications of the cognitive deficits. This study used an exploratory, non-experimental design and the population of interest consisted of occupational therapists providing physical rehabilitation to patients >65 years of age in the United States. The Ecological Systems Model was chosen as the theoretical framework, because it depicts human behavior as the product of the interaction between the individual's personal attributes and the physical and social environment in which the individual functions. Given the changes in health care, and the limits imposed by third party payers, it would seem important to inquire as to the effect of personal and practice contexts on therapists' assessment practices in geriatric rehabilitation.

Although results of the study indicate that factors in the practice context are stronger predictors of therapists' use of standardized cognitive screening and assessment instruments, the study supports principles of Ecological Systems Models in that both practice and personal contexts contribute to therapists' assessment practices.