Paper
Friday, 21 July 2006
This presentation is part of : Issues of the Hospitalized Elderly
Cognitive Function of the Older Hospitalized Patient in Taiwan
Jui-Hua Peng, MS, APRN-BC, GNP, Nursing Department, National Taiwan University Hospital, Taipei, Taiwan
Learning Objective #1: know three factors that related to cognitive function.
Learning Objective #2: name two adverse outcomes in those who have poor cognitive function at admission.
The purpose of this study was to examine the cognitive function of the patients admitted to an acute care geriatric unit. A cross-sectional research design with convenient sampling was done at a medical center in Taipei, Taiwan from the end of 2004 to early 2005. Data were collected from chart review and with a geriatric comprehensive assessment scale including the Mini Mental Status Examination, the Confusion Assessment Method, the short-form Geriatric Depression Scale, the Lawton's Instrumental Activity of Daily Living Scale, and the Barthel Index within 72 hours of admission. Telephone follow-up was also used in 90 days after discharge. Eighty-seven participants were enrolled with the average age of 78.25 +- 9.70 years old. The mean MMSE score was 20.80 +- 6.37 (4-30). Subjects performed best on the MMSE sub-dimension of information registration (54.02% correction rate) while "copy figure" was the dimension that most subjects failed to do (12.64% correction rate). The overall incidence of cognitive impairment among these subjects was 59.18% using the admission MMSE score of 23/24 as the cutoff point. The patients with older age (r=-.262, p<.05), history of stroke (t=2.320, p<.05), or with lower IADL (r=.662) and BI scores (r=.572, p<.01) had lower MMSE scores on admission. The patients with lower MMSE scores had higher mortality rate during hospitalization and within 90 days after discharge (t=10.304, p<.001), more institutionalization within 90 days after discharge (t=3.075, p<.01), and longer length of hospital stay (r=-.267, p<.05). However, there was no statistically significant relationship between the MMSE score and number of medication, number of chronic illness, the CAM score, the GDS score, or number of previous fall. In conclusion, the hospitalized elderly are in the high risk of cognitive impairment, which results in poor outcomes. Assessment of cognitive status among elderly should be considered as a routine.

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