Division of Geriatrics, Department of Medicine. Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA.
Division of Geriatrics, Department of Medicine. Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA.
Arch Gerontol Geriatr. 2019 Nov-Dec;85:103916. doi: 10.1016/j.archger.2019.103916. Epub 2019 Jul 18.
Prior studies have suggested that patients with cognitive impairment are at increased risk for adverse post-hospitalization outcomes. We aimed to determine if cognitive status assessed by the Mini-Cog, a quick bedside screening test, is associated with long-term outcomes.
In this secondary analysis of data from a prospective cohort study, 668 patients >65 years of age admitted to a tertiary care academic hospital over a two-year period were screened for cognitive impairment with the Mini-Cog within 24 h of admission. We performed multivariable regression adjusting for demographics, comorbidities, principal diagnoses and functional status to determine association between cognitive impairment and discharge to post-acute care, 90-day readmission and one-year mortality.
Overall 35% screened positive for cognitive impairment. Those with impairment were older (median age 83 versus 78), less likely to be admitted from home and had lower functional independence and self-reported performance scores (p < 0.001 for all). Patients with cognitive impairment were more likely to be discharged to post-acute care facilities (54% versus 39%, p < 0.001). 90-day readmission rate of patients with and without cognitive impairment was 35% versus 27%; one-year survival 77% versus 84% and median length-of-stay was 4 days for both groups. Differences in readmission and mortality were not statistically significant after adjusting for covariates.
Cognitive impairment as screened for by the Mini-Cog was not associated with readmission, length-of-stay, or 1-year mortality but was associated with discharge to post-acute care. Other tools such as frailty assessment may be more useful in predicting these outcomes in hospitalized older adults.
先前的研究表明，认知障碍患者发生住院后不良结局的风险增加。我们旨在确定通过 Mini-Cog（一种快速床边筛查测试）评估的认知状态是否与长期结局相关。
在一项前瞻性队列研究数据的二次分析中，在两年期间内，对入住三级保健学术医院的 668 名年龄超过 65 岁的患者在入院后 24 小时内使用 Mini-Cog 进行认知障碍筛查。我们进行了多变量回归分析，调整了人口统计学、合并症、主要诊断和功能状态，以确定认知障碍与出院至康复后护理、90 天再入院和 1 年死亡率之间的关系。
总体而言，有 35%的患者筛查出认知障碍。有认知障碍的患者年龄更大（中位数年龄 83 岁 vs 78 岁），更不可能从家中入院，且功能独立性和自我报告的表现评分更低（所有 p 值均＜0.001）。有认知障碍的患者更有可能被送往康复后护理机构（54% vs 39%，p＜0.001）。有认知障碍和无认知障碍的患者的 90 天再入院率分别为 35%和 27%；1 年生存率分别为 77%和 84%，两组的中位住院时间均为 4 天。调整协变量后，再入院和死亡率的差异无统计学意义。
通过 Mini-Cog 筛查出的认知障碍与再入院、住院时间或 1 年死亡率无关，但与出院至康复后护理有关。其他工具，如衰弱评估，可能更有助于预测住院老年患者的这些结局。
