Fortes-Filho Sileno de Queiroz, Aliberti Márlon Juliano Romero, Melo Juliana de Araújo, Apolinario Daniel, Sitta Maria do Carmo, Suzuki Itiro, Garcez-Leme Luiz Eugênio
Institute of Orthopedics and Traumatology, University of Sao Paulo Medical School, Brazil.
School of Health Sciences, Amazonas State University (UEA), Brazil.
J Gerontol A Biol Sci Med Sci. 2022 Jan 7;77(1):172-179. doi: 10.1093/gerona/glab156.
Implementing cognitive assessment in older people admitted to hospital with hip fracture-lying in bed, experiencing pain-is challenging. We investigated the value of a quick and easy-to-administer 10-point Cognitive Screener (10-CS) in predicting 1-year functional recovery and survival after hip surgery.
Prospective cohort study comprising 304 older patients (mean age = 80.3 ± 9.1 years; women = 72%) with hip fracture consecutively admitted to a specialized academic medical center that supports secondary hospitals in Sao Paulo Metropolitan Area, Brazil. The 10-CS, a 2-minute bedside tool including temporal orientation, verbal fluency, and three-word recall, classified patients as having normal cognition, possible cognitive impairment, or probable cognitive impairment on admission. Outcomes were time-to-recovery activities of daily living (ADLs; Katz index) and mobility (New Mobility Score), and survival during 1-year after hip surgery. Hazard models, considering death as a competing risk, were used to associate the 10-CS categories with outcomes after adjusting for sociodemographic and clinical measures.
On admission, 144 (47%) patients had probable cognitive impairment. Compared to those cognitively normal, patients with probable cognitive impairment presented less postsurgical recovery of ADLs (77% vs 40%; adjusted sub-hazard ratio [HR] = 0.44; 95% confidence interval [CI] = 0.32-0.62) and mobility (50% vs 30%; adjusted sub-HR = 0.52; 95% CI = 0.34-0.79), and higher risk of death (15% vs 40%; adjusted HR = 2.08; 95% CI = 1.03-4.20) over 1-year follow-up.
The 10-CS is a strong predictor of functional recovery and survival after hip fracture repair. Cognitive assessment using quick and easy-to-administer screening tools like 10-CS can help clinicians make better decisions and offer tailored care for older patients admitted with hip fracture.
对因髋部骨折入院卧床且疼痛的老年人进行认知评估具有挑战性。我们调查了一种快速且易于实施的10分认知筛查工具（10-CS）在预测髋部手术后1年功能恢复和生存情况方面的价值。
前瞻性队列研究，纳入了304例髋部骨折的老年患者（平均年龄 = 80.3 ± 9.1岁；女性占72%），这些患者连续入住巴西圣保罗大都会地区一家支持二级医院的专业学术医疗中心。10-CS是一种2分钟的床边工具，包括时间定向、语言流畅性和三字回忆，在入院时将患者分类为认知正常、可能存在认知障碍或可能存在认知损害。结局指标为恢复日常生活活动（ADL；Katz指数）和活动能力（新活动能力评分）的时间，以及髋部手术后1年内的生存率。使用考虑死亡为竞争风险的风险模型，在调整社会人口学和临床指标后，将10-CS类别与结局相关联。
入院时，144例（47%）患者可能存在认知损害。与认知正常的患者相比，可能存在认知损害的患者术后ADL恢复情况较差（77%对40%；调整后的亚风险比[HR] = 0.44；95%置信区间[CI] = 0.32 - 0.62），活动能力恢复情况也较差（50%对30%；调整后的亚HR = 0.52；95% CI = 0.34 - 0.79），并且在1年随访期间死亡风险更高（15%对40%；调整后的HR = 2.08；95% CI = 1.03 - 4.20）。
10-CS是髋部骨折修复后功能恢复和生存的有力预测指标。使用像10-CS这样快速且易于实施的筛查工具进行认知评估，可以帮助临床医生做出更好的决策，并为髋部骨折入院的老年患者提供个性化护理。
