Persistent cognitive decline in older hospitalized patients in Taiwan.
OBJECTIVE
This paper is a report of a study conducted to determine the prevalence and predictors of persistent and transient cognitive decline in older hospitalized patients over 6 months after hospital discharge.


BACKGROUND
Cognitive decline occurs in 16-35.5% of older hospitalized patients, but this decline may be persistent rather than transient. Distinguishing persistent from transient cognitive decline is clinically useful.


METHODS
For this prospective cohort study, 291 older patients were recruited from five medical and surgical units at a tertiary medical centre in Taiwan between 2004 and 2006. Participants were assessed for cognitive status by scores on the Mini-Mental State Examination at admission, discharge, 3 and 6 months postdischarge. Persistent cognitive decline was defined as continuing score reduction and > or =3-point reduction 6 months postdischarge. Transient decline was defined as > or = 3-point reduction at some stage, with a total decline < 3 points 6 months postdischarge. Findings. The cognitive status of the majority of participants (57.4%, n = 167) decreased > or =3 points during follow-up. Of these decliners, 59 (35.3%) had persistent cognitive decline, with an average 5.32-point reduction 6 months postdischarge. Forty-six (27.5%) participants experienced transient cognitive decline. After multiple adjustments in logistic regression analysis, persistent decline was predicted by no in-hospital functional decline (OR = 0.16, P = 0.002), more re-admissions after discharge (OR = 2.42, P = 0.020), and older age (OR = 1.09, P = 0.048).


CONCLUSIONS
A new perspective is needed on discharge planning on patients at risk for persistent cognitive decline. Nurses can oversee the delivery of care, identify cognitive decline, refer patients, and educate families on strategies to enhance cognitive functioning for their aging relatives.
Chen
Cheryl Chia-Hui
CC
Department of Nursing, National Taiwan University, Taipei, Taiwan. cherylchen@ntu.edu.tw
Chang
Yue-Cune
YC
Huang
Guan-Hua
GH
Peng
Jui-Hua
JH
Tseng
Chien-Ning
CN
D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003072:Cognition Disorders / Q000453:epidemiology* / Q000451:nursing / Q000503:physiopathology*; D015897:Comorbidity; D003289:Convalescence; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007361:Intelligence Tests / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000592:standards; D011379:Prognosis; D013624:Taiwan / Q000453:epidemiology