Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cog™ Assessments Performed by Advanced Pharmacy Practice Experience Students

Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital - cross-sectional results of the intersec-CM study

BACKGROUND

Cognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of people with cognitive impairments during hospital stays. The aim of the present research is to describe and analyze the treatment needs of people with cognitive impairments in acute hospital care.

METHODS

The analyses use baseline data of the ongoing multisite, longitudinal, randomized controlled intervention trial intersec-CM (Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management), which recruited 402 participants at baseline. We assessed sociodemographic aspects, cognitive status, functional status, frailty, comorbidities, level of impairment, formal diagnosis of dementia, geriatric diagnoses, delirium, depression, pharmacological treatment, utilization of health care services and health care related needs.

RESULTS

The sample under examination had been on average mildly cognitively impaired (MMSE M = 22.3) and had a mild to moderate functional impairment (Barthel Index M = 50.4; HABAM M = 19.1). The Edmonton Frail Scale showed a mean of 7.4 and half of the patients (52.3%) had been assigned a care level. About 46.9% had a geriatric diagnosis, 3.0% had a diagnosis of dementia. According to DSM-V 19.2% of the patients had at least one main symptom of depression. The mean number of regularly taken drugs per patient was 8.2. Utilization of health care services prior to the hospital stay was rather low. On average, the sample showed 4.38 care related needs in general, of which 0.60 needs were unaddressed at the time of assessment.

CONCLUSIONS

Descriptive analyses highlight an in-depth insight into impairments and different care needs of people with cognitive impairments. The results emphasize the need for gender-specific analyses as well as an increased attention to the heterogeneity of needs of people with cognitive impairments related to specific wards, settings and regions where they are admitted. Our results indicate also that people with cognitive impairments represent a high proportion of older patients in acute hospital care.

TRIAL REGISTRATION

The intersec-CM trial is registered at ClinicalTrials.gov ( NCT03359408 ).

Correlation between sleep characteristics and cognitive decline in the elderly people: A cross-sectional study in China

STUDY OBJECTIVES

In this study, we conducted a cross-sectional analysis of the sleep characteristics in the elderly Chinese people to comprehensively investigate the association between sleep and cognitive function in the elderly people. We aimed to evaluate the most important demographic factors, conventional physiological indices and living habits that may influence sleep.

METHODS

We surveyed 2901 elderly people (age ≥60 years old) face-to-face from 1 July to 31 December 2017, who were recruited from 17 communities of the Pudong New Area (Shanghai, China) by probability proportional to size. The Pittsburgh sleep quality index (PSQI) scale was used to describe the sleep features of each participant. Cognitive assessment was performed using the mini-mental state examination (MMSE) scale, Montreal cognitive assessment (MoCA) and the clinical dementia rating (CDR) scale. Those factors which potentially influence sleep and consequentially may impact cognition in the elderly people were evaluated, and the correlations of sleep characteristics and cognitive function were explored by the linear regression analysis.

RESULTS

Altogether, there were 1287 (44.4%) people taking part in the investigation. Sleep quality was significantly correlated with MMSE and MoCA total scores. Healthy sleep (especially enough sleep) was correlated with better cognitive functions. Besides recognised relative factors (such as age, sex and living alone), the number of children was found to be a strong risk factor of poor sleep. Anxiety before sleep and light/noise interference significantly damaged sleep while an exercise routine was associated with better sleep. Moderate levels of reading, watching TV and household work were correlated with superior sleep quality.

CONCLUSION

In conclusion, sleep characteristics correlate with cognitive decline in the elderly people, and they can be influenced by multiple demographic factors and living habits. To improve sleep quality, it may be important to change sleep environment, to be relax, to increase physical exercise and recreational activities moderately.

Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial

BACKGROUND

Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations.

TRIAL DESIGN AND METHODS

This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics.

RESULTS

Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization (p = 0.003) and ED presentations (p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations (p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles (p = 0.019), the participation observed in HOME patients with no support was not significantly improved.

CONCLUSIONS

Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home.

TRIAL REGISTRATION

The trial was registered before commencement (ACTRN12611000615987).

Prevalência e fatores associados ao deficit cognitivo em idosos na comunidade

Resumo Objetivo Estimar a prevalência do deficit cognitivo e verificar associações com variáveis sociodemográficas e de saúde em idosos de Unidades Básicas de Saúde (UBSs) de uma cidade no interior do nordeste brasileiro. Método Estudo transversal de prevalência e associação a respeito da população idosa. Os instrumentos utilizados para coleta dos dados foram Miniexame do Estado Mental (função cognitiva), Escala de Depressão Geriátrica Abreviada (sintomas depressivos), Escala de Lawton (capacidade funcional), Miniavaliação Nutricional (estado nutricional) e teste Timed Get Up and Go (risco de quedas). A associação bivariada entre o deficit cognitivo e as variáveis independentes foi avaliada pelo teste qui-quadrado. A análise multivariada foi feita usando um modelo de regressão logística com as razões de prevalência (RP) e intervalo de confiança de 95% (IC95%). Resultados Foram avaliados 818 idosos. A prevalência de deficit cognitivo foi de 65,9% (IC95%=62,50 - 69,10). Ao compor o modelo de análise multivariada, verificou-se maior ocorrência de deficit cognitivo em indivíduos mais velhos (RP=1,48; IC95%=1,07-2,05), funcionalmente dependentes (RP=3,27; IC95%=2,01-5,10), analfabetos (RP=1,66; IC95%=1,15-2,40) e com risco de desnutrição ou desnutridos (RP=2,09; IC95%=1,47-2,96). Conclusão O presente trabalho evidenciou alta prevalência de deficit cognitivo e que foi associada à idade, escolaridade, capacidade funcional e estado nutricional. É possível questionar se isso se deve à grande quantidade de pessoas com comprometimento cognitivo leve sem demência com remissão posterior dos sintomas, ou pela ocorrência de demência de início precoce.