Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany.
Int J Geriatr Psychiatry. 2019 Apr;34(4):588-593. doi: 10.1002/gps.5056. Epub 2019 Jan 18.
To determine whether the Mini-Cog can be applied by nursing staff to hospitalized elderly patients for cognitive impairment associated risk stratification.
This explorative prospective multicenter cohort study was carried out among 2522 patients aged 70 and older, hospitalized due to physical illness in eight hospitals in Rhineland-Palatinate, Germany. All patients were asked to conduct the Mini-Cog at the day of admission and were clustered into low-performance, intermediate-performance, and good-performance categories by trained nursing staff and two experienced geronto-psychiatrists as gold standard. Complications in the course of the treatment were monitored.
The Mini-Cog was conducted in 1398 (54%) out of 2522 eligible patients. Mini-Cog scores assessed by nursing staff differed from the gold standard in 327 cases (23.9%). According to the area under the curve (AUC), nursing staff identified cognitively low-performing patients almost as well as the geronto-psychiatrists (AUC = 0.862; 95% CI, 0.83-0.89; P < 0.001, accuracy 89.6%). Overall, 241 (17.6%) patients were classified as low performing. These patients had a significantly higher probability of suffering from at least one complication (odds ratio [OR] = 3.13; 95% CI, 2.09-4.70; calculated by a logistic regression model, adjusted for age), and they had a higher probability to show behavioral symptoms.
Even under naturalistic conditions, nursing staff detected cognitively low-performing inpatients with the Mini-Cog. Using this short screening instrument should enable to predict complications of hospitalized older patients associated with cognitive impairment, a precondition to implement targeted care for this vulnerable patient group.
确定护理人员是否可以使用 Mini-Cog 对住院老年患者进行认知障碍相关风险分层。
本探索性前瞻性多中心队列研究在德国莱茵兰-普法尔茨州的 8 家医院共纳入 2522 名年龄在 70 岁及以上、因躯体疾病住院的患者。所有患者在入院当天均被要求进行 Mini-Cog 测试，并由经过培训的护理人员和 2 名经验丰富的老年精神病学家作为金标准将其分为低表现、中表现和高表现类别。监测治疗过程中的并发症。
在 2522 名符合条件的患者中，有 1398 名（54%）进行了 Mini-Cog 测试。护理人员评估的 Mini-Cog 评分与金标准在 327 例（23.9%）中存在差异。根据曲线下面积（AUC），护理人员识别认知功能低下患者的效果几乎与老年精神病学家一样好（AUC=0.862；95%CI，0.83-0.89；P<0.001，准确性 89.6%）。总体而言，241 名（17.6%）患者被归类为表现不佳。这些患者发生至少一种并发症的概率显著更高（优势比[OR]=3.13；95%CI，2.09-4.70；通过逻辑回归模型计算，调整年龄因素），并且他们发生行为症状的概率更高。
即使在自然条件下，护理人员也能使用 Mini-Cog 检测出认知功能低下的住院患者。使用这种简短的筛查工具应该能够预测与认知障碍相关的住院老年患者的并发症，这是为这一脆弱患者群体实施有针对性护理的前提。
