Paper
Thursday, July 14, 2005
Cognitive, Nutritional, and Functional Decline Associated With Hospitalization in Older Taiwanese Patients Admitted for Med-Surgical Services
Cheryl Chia-Hui Chen, DNSc, GNP1, Guan-Hua Huang, PhD2, Yueh-Chan Hung, RN, BSN1, and Yu-Lun Liu, MS2. (1) School of Nusing, National Taiwan University, Taipei, Taiwan, (2) Institute of Statistics, National Chiao-Tung University, Hsinchu, Taiwan
| Learning Objective #1: Understand the significance of cognitive, nutritional, and functional decline associated with hospitalization in older adults |
| Learning Objective #2: Identify the predictors of nutritional and functional decline associated with hospitalization in older adults |
Background and Aims: Numerous studies have shown that most markers of cognition, nutrition, and function deteriorate steadily during hospitalization and such deteriorations significantly affect clinical outcomes. The aim of this prospective study was to examine the independent and interactive effects of acute illness on the course and magnitude of cognitive, nutritional, and functional decline in older Taiwanese patients. Methods: The study population consisted of 114 subjects who completed the comprehensive geriatric assessment at admission - most were older (74.2°"4.6years) and less educated (85% <=2 years schooling). Subjects who had a length of stay longer than 5 days were assessed again before discharge (n=70). The cognitive, nutritional, and functional status were assessed alone with demographics, comorbidities, medication, oral health, social support, depressive symptoms, laboratory variables, and treatment-related factors (NPO days, length of stay, admission diagnosis, and cost of care) by a trained research nurses. Results: The data indicated that cognitive, nutritional, and ADL functional impairments occurred frequently, in approximately 10-47% of older hospitalized patients at admission. Although cognitive status measured by the Mini-Mental Sate Examination (MMSE) was slightly improved during the course of hospitalization (from 25.97 to 26.34), the nutritional status measured by the Mini-Nutritional Assessment (MNA) and functional status measured by the Barthal Index were declined significantly, compared to the admission baseline (t=-3.54, p=.0007, t=-10.07, p<.000, respectively). Predictive model for nutrition and function decline associated with hospitalization was developed. Significant predictors included depressive symptoms, length of stay, number of medication, cognitive impairment, and weight loss in the prior six months. Nursing Implication: In hospital setting, nurses are ideally positioned to screen for cognition, nutrition, and function decline. Knowledge about the predictors of such declines can advance nursing sciences and might lead to targeted, cost-effective interventions for older hospitalized Taiwanese patients who admitted for medical and surgical services.