Lee A Lindquist1, Lise Go, Jori Fleisher, Nelia Jain, David Baker. 1. Division of Geriatrics, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA. LAL425@md.northwestern.edu
Abstract
BACKGROUND: Seniors frequently struggle during the transition home following an acute hospitalization resulting in frequent rehospitalizations. Studies consistently show a lack of comprehension of discharge instructions. OBJECTIVES: To determine the frequency of low cognition at hospital discharge among community dwelling seniors and the changes in cognition that occur one month following hospitalization. DESIGN: Face-to-face surveys were performed at hospital discharge and one month later in the home of the subject. The Mini-Mental Status Examination (MMSE), Backward Digit Span, and 15 Word Immediate and Delayed Recall Tests were used to evaluate cognition. Low cognition was determined to be a score of less than 25 on the MMSE for subjects with high school education and less than 18 for subjects with less than high school education. PARTICIPANTS: Two hundred community-dwelling seniors ≥ 70 years, admitted to acute medicine services >24 hours, consenting to their own procedures, not having previously documented cognitive loss, and not admitted for cognitive changes. RESULTS: Upon hospital discharge, 31.5% of subjects had previously unrecognized low cognition. One month later, 58% of these patients no longer had low cognition (p < 0.001). Of those subjects with low cognition, the MMSE improved by an average of 4 points one month post-discharge. Within the MMSE, subjects experienced significant improvements in the areas of orientation, registration, repetition, comprehension, naming, reading, writing, and calculation. CONCLUSION: Low cognition at discharge is common among elderly patients without dementia, and cognition often improves one month post-hospitalization. Seniors may not comprehend discharge instructions, and patient self-management may be better taught as an outpatient following discharge rather than at the time of hospital discharge. Discharge interventions should incorporate screening of seniors for low cognition prior to hospital discharge to provide optimal transitional care.
BACKGROUND: Seniors frequently struggle during the transition home following an acute hospitalization resulting in frequent rehospitalizations. Studies consistently show a lack of comprehension of discharge instructions. OBJECTIVES: To determine the frequency of low cognition at hospital discharge among community dwelling seniors and the changes in cognition that occur one month following hospitalization. DESIGN: Face-to-face surveys were performed at hospital discharge and one month later in the home of the subject. The Mini-Mental Status Examination (MMSE), Backward Digit Span, and 15 Word Immediate and Delayed Recall Tests were used to evaluate cognition. Low cognition was determined to be a score of less than 25 on the MMSE for subjects with high school education and less than 18 for subjects with less than high school education. PARTICIPANTS: Two hundred community-dwelling seniors ≥ 70 years, admitted to acute medicine services >24 hours, consenting to their own procedures, not having previously documented cognitive loss, and not admitted for cognitive changes. RESULTS: Upon hospital discharge, 31.5% of subjects had previously unrecognized low cognition. One month later, 58% of these patients no longer had low cognition (p < 0.001). Of those subjects with low cognition, the MMSE improved by an average of 4 points one month post-discharge. Within the MMSE, subjects experienced significant improvements in the areas of orientation, registration, repetition, comprehension, naming, reading, writing, and calculation. CONCLUSION:Low cognition at discharge is common among elderly patients without dementia, and cognition often improves one month post-hospitalization. Seniors may not comprehend discharge instructions, and patient self-management may be better taught as an outpatient following discharge rather than at the time of hospital discharge. Discharge interventions should incorporate screening of seniors for low cognition prior to hospital discharge to provide optimal transitional care.
Authors: Eric A Coleman; Jodi D Smith; Janet C Frank; Sung-Joon Min; Carla Parry; Andrew M Kramer Journal: J Am Geriatr Soc Date: 2004-11 Impact factor: 5.562
Authors: Alan J Forster; Heather D Clark; Alex Menard; Natalie Dupuis; Robert Chernish; Natasha Chandok; Asmat Khan; Carl van Walraven Journal: CMAJ Date: 2004-02-03 Impact factor: 8.262
Authors: Lee A Lindquist; Lise Go; Jori Fleisher; Nelia Jain; Elisha Friesema; David W Baker Journal: J Gen Intern Med Date: 2011-10-05 Impact factor: 5.128
Authors: Anna H Chodos; Margot B Kushel; S Ryan Greysen; David Guzman; Eric R Kessell; Urmimala Sarkar; L Elizabeth Goldman; Jeffrey M Critchfield; Edgar Pierluissi Journal: J Gen Intern Med Date: 2015-12 Impact factor: 5.128
Authors: Alicia I Arbaje; Devan L Kansagara; Amanda H Salanitro; Honora L Englander; Sunil Kripalani; Stephen F Jencks; Lee A Lindquist Journal: J Gen Intern Med Date: 2014-06 Impact factor: 5.128