Implementing functional cognition interventions in a hospital-based setting

Functional cognition is an important aspect of occupational therapy practice. This concept is defined as “the ability to use and integrate thinking and performance skills to accomplish complex everyday activities" (Giles et al., 2020, p. 1). Much of the current body of research surrounding functional cognition focuses on practice in community and outpatient settings, where patients are medically stable, ambulatory, and physically high functioning. However, according to the American Occupational Therapy Association’s (AOTA’s) 2019 Workforce and Salary Survey (2020), 28.6% of occupational therapy practitioners (OTPs) work in hospital-based settings. As expected, patients in a hospital environment present with a variety of deficits and are often in great need of functional cognitive assessment and intervention to improve their overall occupational performance. However, it is challenging for OTPs to directly apply the current assessment and intervention principles in the literature to hospital-based practice, where the patient population is medically active and low functioning from both a cognitive and physical standpoint. The recent push for quick patient discharges further complicates this matter. AOTA has advocated to the Centers for Medicare & Medicaid Services for inclusion of functional cognitive screening as part of standard data collection procedures in post-acute care settings (Giles et al., 2020). At this time, there is no appropriate screening tool available, creating another roadblock to successfully integrating functional cognitive principles in hospital-based settings.