Cognitive Status and Outcomes of Older People in Orthopedic Rehabilitation? A Retrospective-Cohort Study

Abstract

Background: Cognitive function of older people is not routinely assessed in orthopedic rehabilitation, after elective and non-elective surgery. The aim of this study was to assess cognitive impairment and its impact on both length of stay and functional outcomes, of older people admitted to orthopedic rehabilitation. Methods: Retrospective audit, inclusion criteria: aged >65 years, orthopedic diagnosis, discharged from hospital. Results: 116 files were audited, mean age of 82.3 (SD = 7.5) years. Diagnostic groups: fractured neck of femur, (n = 44, 37.98%); elective surgery (n = 42, 36.21%); and other orthopedic conditions (n = 30, 25.86%). Overall 71.55% (n = 83) had cognitive impairment, with a median of mild cognitive impairment across all diagnoses. Both measures of cognition (MoCA/FIM Cognitive) were significantly associated with length of stay (p < 0.01), function (p < 0.05), and discharge destination (p = 0.01). Conclusions: A high percentage of older orthopedic patients in rehabilitation with both elective and non-elective diagnoses have cognitive impairment. Cognitive screening is recommended for all older orthopedic patients in rehabilitation, to inform an individualized rehabilitation plan to improve outcomes and length of stay. Further research is required to explore cognitive strategies to maximize rehabilitation outcomes in the geriatric orthopedic population.

“Associations between patient characteristics and unplanned or delayed discharges from geriatric rehabilitation: A retrospective chart review”

“…The median age of participants in our study is consistent with data from a systematic review of randomized controlled trials of inpatient geriatric rehabilitation, which reported mean ages of participants in the included studies ranging from 74.2 to 86.0 2 . In addition, the final cohort of 251 patients over a 1-yr period constitutes one of the larger chart reviews of geriatric rehabilitation populations, which have abstracted data from between 116 and 215 charts 3,4,33,35 . As with most chart abstraction, the data relied on accurate documentation by nurses, physicians, and allied health members, which may be subject to human error and lead to exposure misclassification of certain variables.…”

“…I npatient geriatric rehabilitation has been shown to improve function, reduce admission to long-term care, and reduce mortality when compared with usual inpatient care without rehabilitation. 1,2 The majority of rehabilitation literature on older adults focuses on specific patient populations-including orthopedic, [3][4][5][6] oncology, 7 and stroke. 8,9 However, the bulk of the current literature focuses on rehabilitation candidates and outcomes on the basis of their diagnosis, rather than a general older adult population who experiences a hospitalization.…”

Comparison of the Brief Interview for Mental Status (BIMS) and Montreal Cognitive Assessment (MoCA) for identifying cognitive impairments and predicting rehabilitation outcomes in an inpatient rehabilitation facility

“…25 Relationships with MoCA scores and functional rehabilitation outcomes have been reported for patients with lower extremity amputations 5 and patients with hip fracture. 1 Recently Marks and colleagues (2021) found that the MoCA was more sensitive than the BIMS in predicting impairments in instrumental ADLs (iADLs; including checkbook balancing and shopping tasks) among older community dwellers. 26 Identification of patients who may have difficulty with functional and instrumental ADLs is important in creating a safe home discharge plan for patients and caregivers following an IRF stay.…”

“…Patient cognition is affected not only by the acute injury or illness leading to hospitalization but is often layered on top of delirium, mild cognitive disorders, or dementia that may or may not have been diagnosed previously. Impaired cognition is common not only for patients recovering from stroke or brain injury, but patients with hip fracture, 1,2 coronary heart disease, 3 chronic obstructive pulmonary disease, 4,5 and lower extremity amputations 5 …”

“…When compared with the MMSE, the MoCA has less of a ceiling effect and stronger relationships with functional measures for stroke patients upon discharge from acute rehabilitation 25 . Relationships with MoCA scores and functional rehabilitation outcomes have been reported for patients with lower extremity amputations 5 and patients with hip fracture 1 . Recently Marks and colleagues (2021) found that the MoCA was more sensitive than the BIMS in predicting impairments in instrumental ADLs (iADLs; including checkbook balancing and shopping tasks) among older community dwellers 26 .…”