Department of Nursing, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Adv Nurs. 2012 Jun;68(6):1322-9. doi: 10.1111/j.1365-2648.2011.05842.x. Epub 2011 Oct 11.
This article is a report on a pilot study conducted to determine the effects of cognitively stimulating activities in older patients undergoing elective hip and/or knee replacement.
Cognitive decline occurs in 16-35·5% of older hospitalized patients. In-hospital interventions, such as cognitively stimulating activities, might combat cognitive decline. However, evidence supporting such interventions is limited.
For this randomized pilot trial, 50 older patients (90% women with a mean age of 72·8 years) were recruited in 2008 from a tertiary medical centre in Taiwan. While hospitalized, participants in the intervention group received a daily nurse-led, individual-based, cognitive-stimulation intervention. The comparison group received usual care. Cognitive function was assessed using Mini-Mental State Examination at admission, discharge and 1 month after discharge.
The incidence of cognitive decline (≥2-point decline in cognitive score) by hospital discharge was significantly lower for the intervention group (12%) than the usual care group (44%). The intervention group also had better cognitive scores following hospitalization. Upon discharge, participants in the intervention group scored 1·28 points higher than at admission, whereas participants in the usual care declined by 0·76 points. Improvement in cognitive status persisted for the intervention group (+1·33 points) vs. usual care (-0·26 points) at 1 month after discharge. Group differences in changes were statistically significant both at discharge and 1 month afterwards.
Our cognitive-stimulation intervention benefited global cognitive function among older patients undergoing elective hip and/or knee replacement. The benefit persisted at 1 month after discharge.
本文报告了一项关于认知刺激活动对择期髋关节和/或膝关节置换老年患者影响的初步研究。
16-35.5%的老年住院患者会出现认知能力下降。住院期间的干预措施，如认知刺激活动，可能有助于对抗认知能力下降。然而，支持这些干预措施的证据有限。
本随机初步试验于 2008 年在台湾的一家三级医疗中心招募了 50 名老年患者（90%为女性，平均年龄 72.8 岁）。在住院期间，干预组的参与者接受了由护士主导的、基于个体的、认知刺激干预。对照组接受常规护理。在入院、出院和出院后 1 个月时使用简易精神状态检查评估认知功能。
出院时认知下降（认知评分下降≥2 分）的发生率，干预组（12%）显著低于常规护理组（44%）。住院后，干预组的认知评分也更好。出院时，干预组的得分比入院时高 1.28 分，而常规护理组下降了 0.76 分。干预组的认知状态改善持续到出院后 1 个月（+1.33 分），而常规护理组则下降了（-0.26 分）。出院时和出院后 1 个月时，两组在变化方面的差异均具有统计学意义。
我们的认知刺激干预措施使择期髋关节和/或膝关节置换的老年患者的整体认知功能受益。这种益处在出院后 1 个月仍持续存在。
