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In both primary care and the ED, recognition of cognitive impairment has repeatedly been shown to be poor. In the chronic context, cognitive assessment is needed to monitor risk of dementia for people likely to have cognitive impairment ( Petersen et al., 2001). Cognitive screening of older people is important to monitor chronic (e.g., dementia) or acute (e.g., delirium) changes in cognitive status. The rise in healthcare expenditures due to age-related conditions has prompted research on how to minimize costs while maximizing care for adults through early screening, monitoring and intervention methods ( Zaslavsky et al., 2012). The cost of healthcare spending per adult aged 65 years and older has been estimated to be three to five times more than the corresponding cost for younger individuals ( Glass and Balfour, 2003 Centers for Disease Control and Prevention, 2013). In many countries, aging populations place serious demands on healthcare systems. We observed a test-retest reliability of the serious game (as assessed by correlation r-values) between 0.5 and 0.8 across adjacent sessions.Ĭonclusion: The game-based assessment for cognitive screening has relatively strong test-retest reliability and little evidence of practice effects among elderly emergency patients, and may be a useful supplement to existing cognitive assessment methods. Results: A total of 114 adults (61 females, 53 males) between the ages of 70 and 104 years ( M = 81 years, SD = 7) participated in our study after screening out delirious patients. Each patient played our serious game in an initial session soon after they arrived in the ED, and in follow up sessions conducted at 8-h intervals (for each participant there were up to five follow up sessions, depending on how long the person stayed in the ED). Materials and Methods: Adults over the age of 70 were recruited from a hospital ED. A secondary objective is to assess whether there are practice effects that might make game performance unstable over repeated presentations. Objective: To demonstrate the test-retest reliability of the screening tool over time in a clinical sample of older emergency patients. In this paper, we examine the test-retest reliability of the game, as it is an important criterion in a cognitive test for detecting risk of delirium onset. In earlier research we examined the concurrent validity of a serious game, and carried out an initial assessment of its potential as a delirium screening tool ( Tong et al., 2016). Given the demands on emergency staff, an automated cognitive test to screen for delirium onset could be a valuable tool to support delirium prevention and management. Failure to recognize delirium can have devastating consequences including increased mortality ( Kakuma et al., 2003). Literature has shown that the presence of cognitive impairments such as dementia and delirium are often missed in older ED patients. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Introduction: Cognitive screening in settings such as emergency departments (ED) is frequently carried out using paper-and-pencil tests that require administration by trained staff. 5Clinical Epidemiology Unit, Department of Emergency Services, Sunnybrook Health Sciences Center, Toronto, ON, Canada.
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4Primary Care Research Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.3Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.2Knowledge Media Design Institute, Faculty of Information, University of Toronto, Toronto, ON, Canada.1Interactive Media Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.Tiffany Tong 1,2* Mark Chignell 1,2 Mary C.