Senile confusion: limitations of assessment by the face-hand test, mental status questionnaire, and staff ratings.

Three of the most common and convenient measures of senile confusion are informal staff ratings, the Face-Hand Test (FHT) and the Mental Status Questionnaire (MSQ). A group of 112 geriatric patients in two extended care facilities, and a volunteer sample of 40 community aged were examined by means of the FHT and MSQ. These instruments proved valuable in differentiating patients rated as confused from those rated as lucid and alert, and from the community subjects. However, each of these measures, as well as the staff ratings, produced false negative findings. Staff ratings incorrectly identified a hypochondriacal and paranoid patient as confused. The FHT scores of lucid and alert patients with some brain damage were low. MSQ scores of some poorly educated immigrants were very low, even though these patients were rated as lucid and alert by the staff and passed the FHT. One normally lucid and alert patient with a fever and an irregular rapid pulse failed both the FHT and the MSQ. Guidelines for further use of these instruments are presented.