The purpose of this quantitative and qualitative descriptive study was to examine the differences in mental status at morning and evening hours of the day among elderly nursing home residents and to describe behaviors and environmental cues associated with changes in mental status. Residents, aged 70 to 90 years who were mobile, were selected from a sample of convenience at a 100-bed rural nursing home in West Central Alabama. A total of 48 residents, 33 females and 15 males, participated in the study. Demographic data were obtained from the health care records. Mental status of each subject was measured, using Pfeiffer's (1975) Short Portable Mental Status Questionnaire (SPMSQ), twice a day for 3 days during a 3 week period. A description of behaviors and environmental cues associated with changes in mental status also were recorded at each observation. The hypothesis of this study was that there would be a decline in mental status from the morning hours to the evening hours among elderly nursing home residents. The mean SPMSQ scores for morning and evening were analyzed using the _t test statistic at the .05 level of confidence. Because the t-value of these scores was not significant, the hypothesis was rejected. Although not statistically significant, changes in the mental status of some elders were noted during the sequential observations. Although no single pattern of behavior was associated with these changes in mental status, a variety of restless and verbal behaviors were observed, in both morning and evening hours, especially in confused residents. Environmental cues observed with changes in mental status were dim lighting; absence of calendars and clocks in many rooms; social isolation; lack of meaningful activities; and limited engagement in activities.


Master of Science in Nursing (MSN)


Graduate Nursing

Degree Date


Publication Number


First Advisor

Dr. Virginia Cora

Second Advisor

Dr. Rayma Skinner

Document Type


Included in

Nursing Commons