Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
Division of Neurology, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
Int J Environ Res Public Health. 2022 Jan 5;19(1):584. doi: 10.3390/ijerph19010584.
Cognitive dysfunction commonly occurs among older patients during admission and is associated with adverse prognosis. This study evaluated clinical characteristics and outcome determinants in hospitalized older patients with cognitive disorders. The main outcomes were length of stay, readmission within 30 days, Barthel index (BI) score at discharge, BI score change (discharge BI score minus BI score), and proportion of positive BI score change to indicate change of activities of daily living (ADL) change during hospitalization. A total of 642 inpatients with a mean age of 79.47 years (76-103 years) were categorized into three groups according to the medical history of dementia, and Mini-Mental State Examination (MMSE) scores at admission. Among them, 74 had dementia diagnosis (DD), 310 had cognitive impairment (CI), and 258 had normal MMSE scores. Patients with DD and CI generally had a higher risk of many geriatric syndromes, such as multimorbidities, polypharmacy, delirium, incontinence, visual and auditory impairment, fall history, physical frailty. They had less BI score, BI score change, and proportion of positive BI score change ADL at discharge. (DD 70.0%, CI 79.0%), suggesting less ADL change during hospitalization compared with those with normal MMSE scores (92.9%; < 0.001). Using multiple regression analysis, we found that among patients with DD and CI, age ( = 0.008) and walking speed ( = 0.023) were predictors of discharge BI score. In addition, age ( = 0.047) and education level were associated with dichotomized BI score change (positive vs. non-positive) during hospitalization. Furthermore, the number and severity of comorbidities predicted LOS ( < 0.001) and readmission ( = 0.001) in patients with cognitive disorders. It is suggested that appropriate strategies are required to improve clinical outcomes in these patients.
认知功能障碍在住院老年患者中较为常见，与不良预后相关。本研究评估了伴有认知障碍的住院老年患者的临床特征和结局决定因素。主要结局包括住院时间、30 天内再入院、出院时的巴氏指数（Barthel index，BI）评分、BI 评分变化（出院 BI 评分减去入院 BI 评分）以及 BI 评分变化为阳性的比例，以指示住院期间日常生活活动（activities of daily living，ADL）的变化。共纳入 642 名平均年龄为 79.47 岁（76-103 岁）的住院患者，根据痴呆病史和入院时的简易智力状态检查（Mini-Mental State Examination，MMSE）评分分为三组。其中，74 名患者诊断为痴呆（dementia，DD），310 名患者有认知障碍（cognitive impairment，CI），258 名患者 MMSE 评分正常。DD 和 CI 患者通常存在多种老年综合征的风险较高，如多病共存、多种药物治疗、谵妄、失禁、视力和听力障碍、跌倒史、身体虚弱等。他们的 BI 评分、BI 评分变化和阳性 BI 评分变化比例较低，ADL 出院时的变化较小（DD 70.0%，CI 79.0%），与 MMSE 评分正常的患者相比（92.9%；<0.001），住院期间 ADL 变化较小。使用多元回归分析，我们发现 DD 和 CI 患者中，年龄（ = 0.008）和行走速度（ = 0.023）是出院 BI 评分的预测因素。此外，年龄（ = 0.047）和教育程度与住院期间 BI 评分变化（阳性与非阳性）有关。此外，共病数量和严重程度预测了认知障碍患者的住院时间（<0.001）和再入院（ = 0.001）。建议需要采取适当的策略来改善这些患者的临床结局。
