Study Population

This cross-sectional, observational study (Vanderbilt University IRB #162074) was conducted in a 140-bed long-term care facility offering intermediate and skilled levels of nursing care for veterans and their spouses in the Southeast United States ({"type":"clinical-trial","attrs":{"text":"NCT03209960","term_id":"NCT03209960"}}NCT03209960). All 129 inpatient residents of the facility at the time of enrollment (December 2017 to February 2018) were approached for recruitment. The study neurologist and nursing staff at the facility made the determination whether each resident was cognitively capable of providing informed consent. A total of 59 residents were determined to be cognitively capable of providing informed consent and were approached for participation in-person by the principal investigator and study staff at the facility. A total of 70 residents were determined to be cognitively incapable of providing informed consent, and informational packets with informed consent forms were mailed to their medical decision makers. Study personnel also approached available medical decision makers at the facility and, if agreeable to participation, acquired proxy consent onsite. Written informed consent was obtained for all study participants, either directly by participants or their medical decision makers. This study was conducted in accordance with the Declaration of Helsinki.