The association of cognitive impairment as screened by the Mini-Cog with long term post-hospitalization outcomes.

Autor: Shami A; Division of Geriatrics, Department of Medicine. Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA. Electronic address: ashami24@gmail.com., Brennan M; Division of Geriatrics, Department of Medicine. Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA., Marie PS; Office of Research, Epidemiology/Biostatistics Research Core. University of Massachusetts Medical School - Baystate, 3601 Main St., Springfield, MA 01199, USA., Lindenauer PK; Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School - Baystate, 3601 Main St., Springfield, MA 01199, USA., Stefan MS; Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School - Baystate, 3601 Main St., Springfield, MA 01199, USA. Electronic address: mihaela.stefan@baystatehealth.org.
Jazyk: angličtina
Zdroj: Archives of gerontology and geriatrics [Arch Gerontol Geriatr] 2019 Nov - Dec; Vol. 85, pp. 103916. Date of Electronic Publication: 2019 Jul 18.
DOI: 10.1016/j.archger.2019.103916
Abstrakt: Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
(Copyright © 2019 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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