C0200: Repetition of Three Words

Item Rationale

Health-related Quality of Life

• Inability to repeat three words on first attempt may indicate:

— a memory impairment,

— a hearing impairment,

— a language barrier, or

— inattention that may be a sign of delirium or another health issue.

Planning for Care

• A cue can assist learning.

• Cues may help residents with memory impairment who can store new information in their memory but who have trouble retrieving something that was stored (e.g., not able to remember someone’s name but can recall if given part of the first name).

• Staff can use cues when assisting residents with learning and recall in therapy, and in daily and restorative activities.

Steps for Assessment

Basic BIMS interview instructions are shown on pages C-4 and C-5. In addition, for repetition of three words:

1. Say to the resident: “I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are: sock, blue, and bed.” Interviewers need to use the words and related category cues as indicated. If the interview is being conducted with an interpreter present, the interpreter should use the equivalent words and similar, relevant prompts for category cues.

2. Immediately after presenting the three words, say to the resident: “Now please tell me the three words.”

3. After the resident’s first attempt to repeat the items:

• If the resident correctly stated all three words, say, “That’s right, the words are sock, something to wear; blue, a color; and bed, a piece of furniture” [category cues].

• Category cues serve as a hint that helps prompt residents’ recall ability. Putting words in context stimulates learning and fosters memory of the words that residents will be asked to recall in item C0400, even among residents able to repeat the words immediately.

• If the resident recalled two or fewer words, say to the resident: “Let me say the three words again. They are sock, something to wear; blue, a color; and bed, a piece of furniture. Now tell me the three words.” If the resident still does not recall all three words correctly, you may repeat the words and category cues one more time.

• If the resident does not repeat all three words after three attempts, re-assess ability to hear. If the resident can hear, move on to the next question. If they are unable to hear, attempt to maximize hearing (alter environment, use hearing amplifier) before proceeding.

Coding Instructions

Record the maximum number of words that the resident correctly repeated on the first attempt. This will be any number between 0 and 3.

• The words may be recalled in any order and in any context. For example, if the words are repeated back in a sentence, they would be counted as repeating the words.

• Do not score the number of repeated words on the second or third attempt. These attempts help with learning the item, but only the number correct on the first attempt go into the total score. Do not record the number of attempts that the resident needed to complete.

• Code 0, none: if the resident did not repeat any of the 3 words on the first attempt.

• Code 1, one: if the resident repeated only 1 of the 3 words on the first attempt.

• Code 2, two: if the resident repeated only 2 of the 3 words on the first attempt.

• Code 3, three: if the resident repeated all 3 words on the first attempt.

Examples

1. The interviewer says, “The words are sock, blue, and bed. Now please tell me the three words.” The resident replies, “Bed, sock, and blue.” The interviewer repeats the three words with category cues, by saying, “That’s right, the words are sock, something to wear; blue, a color; and bed, a piece of furniture.”

Coding: C0200 would be coded 3, three words correct.

Rationale: The resident repeated all three items on the first attempt. The order of repetition does not affect the score.

2. The interviewer says, “The words are sock, blue, and bed. Now please tell me the three words.” The resident replies, “Sock, bed, black.” The interviewer repeats the three words plus the category cues, saying, “Let me say the three words again. They are sock, something to wear; blue, a color; and bed, a piece of furniture. Now tell me the three words.” The resident says, “Oh yes, that’s right, sock, blue, bed.”

Coding: C0200 would be coded 2, two of three words correct.

Rationale: The resident repeated two of the three items on the first attempt. Residents are scored based on the first attempt.

3. The interviewer says, “The words are sock, blue, and bed. Now please tell me the three words.” The resident says, “Blue socks belong in the dresser.” The interviewer codes according to the resident’s response. Then the interviewer repeats the three words plus the category cues, saying, “Let me say the three words again. They are sock, something to wear; blue, a color; and bed, a piece of furniture. Now tell me the three words.” The resident says, “Oh yes, that’s right, sock, blue, bed.”

Coding: C0200 would be coded 2, two of the three words correct.

Rationale: The resident repeated two of the three items—blue and sock on the first attempt. The resident put the words into a sentence, resulting in the resident repeating twoof the three words.

4. The interviewer says, “The words are sock, blue, and bed. Now please tell me the three words.” The resident replies, “What were those three words?” The resident’s response is coded, and then the interviewer repeats the three words plus the category cues.

Coding: C0200 would be coded 0, none of the words correct.

Rationale: The resident did not repeat any of the three words after the first time the interviewer said them.

DEFINITION

CATEGORY CUE

Phrase that puts a word in context to help with learning and to serve as a hint that helps prompt the resident. The category cue for sock is “something to wear.” The category cue for blue is “a color.” For bed, the category cue is “a piece of furniture.”