Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, 31905, Haifa, Israel.
The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel.
BMC Geriatr. 2022 Sep 12;22(1):739. doi: 10.1186/s12877-022-03398-5.
Cognitive assessment in acutely hospitalized older adults is mainly limited to neuropsychological screening measures of global cognition. Performance-based assessments of functional cognition better indicate functioning in real-life situations. However, their predictive validity has been less studied in acute hospital settings. The aim of this study was to explore the unique contribution of functional cognition screening during acute illness hospitalization in predicting participation of older adults one and three months after discharge beyond traditional neuropsychological measures.
This prospective longitudinal study included 84 older adults ≥ 65 years hospitalized in internal medicine wards due to acute illness, followed by home visits at one month and telephone interviews at three months (n = 77). Participation in instrumental activities of daily living, social and leisure activities was measured by the Activity Card Sort. In-hospital factors included cognitive status (telephone version of the Mini-Mental State Examination, Color Trails Test), functional cognition screening (medication sorting task from the alternative Executive Function Performance Test), emotional status (Hospital Anxiety and Depression scale), functional decline during hospitalization (modified Barthel index), length of hospital stay, the severity of the acute illness, symptoms severity and comorbidities.
Functional cognition outperformed the neuropsychological measures in predicting participation declines in a sample of relatively high-functioning older adults. According to a hierarchical multiple linear regression analysis, the overall model explained 28.4% of the variance in participation after one month and 19.5% after three months. Age and gender explained 18.6% of the variance after one month and 13.5% after three months. The medication sorting task explained an additional 5.5% of the variance of participation after one month and 5.1% after three months, beyond age and gender. Length of stay and the Color Trails Test were not significant contributors to the change in participation.
By incorporating functional cognition into acute settings, healthcare professionals would be able to better detect older adults with mild executive dysfunctions who are at risk for participation declines. Early identification of executive dysfunctions can improve continuity of care and planning of tailored post-discharge rehabilitation services, especially for high-functioning older adults, a mostly overlooked population in acute settings. The results support the use of functional cognition screening measure of medication management ability in acute settings.
急性住院的老年患者认知评估主要局限于整体认知的神经心理学筛查测试。基于表现的认知功能评估能更好地反映现实生活中的功能。然而，它们在急性医院环境中的预测效度研究较少。本研究旨在探讨急性住院期间进行的功能认知筛查对出院后一个月和三个月时老年患者参与情况的独特预测作用，其预测作用超过传统的神经心理学测量。
这项前瞻性纵向研究纳入了 84 名因急性疾病入住内科病房的年龄≥65 岁的老年患者，随后在一个月时进行家访，在三个月时进行电话访谈（n=77）。日常活动工具性活动参与情况由活动卡片分类法进行测量。住院期间的因素包括认知状态（电话版简易精神状态检查、色连线测试）、功能认知筛查（替代执行功能测试中的药物分类任务）、情绪状态（医院焦虑和抑郁量表）、住院期间的功能下降（改良巴氏指数）、住院时间、急性疾病的严重程度、症状严重程度和合并症。
在一个相对高功能的老年患者样本中，功能认知在预测参与度下降方面优于神经心理学测量。根据分层多元线性回归分析，整体模型解释了一个月后参与度变化的 28.4%，三个月后为 19.5%。年龄和性别解释了一个月后参与度变化的 18.6%，三个月后为 13.5%。药物分类任务在一个月后解释了参与度变化的额外 5.5%，三个月后为 5.1%，超过了年龄和性别。住院时间和色连线测试对参与度的变化没有显著贡献。
通过将功能认知纳入急性治疗环境，医疗保健专业人员能够更好地发现有轻度执行功能障碍风险的老年患者，这些患者有参与度下降的风险。早期识别执行功能障碍可以改善连续性护理和定制出院后康复服务的规划，特别是对急性环境中大多数被忽视的高功能老年患者。结果支持在急性治疗环境中使用药物管理能力的功能认知筛查测量。
