The contribution of functional cognition screening during acute illness hospitalization of older adults in predicting participation in daily life after discharge

Abstract

Background Cognitive assessment in acutely hospitalized older adults is mainly limited to neuropsychological screening measures of global cognition. Performance-based assessments of functional cognition better indicate functioning in real-life situations. However, their predictive validity has been less studied in acute hospital settings. The aim of this study was to explore the unique contribution of functional cognition screening during acute illness hospitalization in predicting participation of older adults one and three months after discharge beyond traditional neuropsychological measures. Methods This prospective longitudinal study included 84 older adults ≥ 65 years hospitalized in internal medicine wards due to acute illness, followed by home visits at one month and telephone interviews at three months (n = 77). Participation in instrumental activities of daily living, social and leisure activities was measured by the Activity Card Sort. In-hospital factors included cognitive status (telephone version of the Mini-Mental State Examination, Color Trails Test), functional cognition screening (medication sorting task from the alternative Executive Function Performance Test), emotional status (Hospital Anxiety and Depression scale), functional decline during hospitalization (modified Barthel index), length of hospital stay, the severity of the acute illness, symptoms severity and comorbidities. Results Functional cognition outperformed the neuropsychological measures in predicting participation declines in a sample of relatively high-functioning older adults. According to a hierarchical multiple linear regression analysis, the overall model explained 28.4% of the variance in participation after one month and 19.5% after three months. Age and gender explained 18.6% of the variance after one month and 13.5% after three months. The medication sorting task explained an additional 5.5% of the variance of participation after one month and 5.1% after three months, beyond age and gender. Length of stay and the Color Trails Test were not significant contributors to the change in participation. Conclusions By incorporating functional cognition into acute settings, healthcare professionals would be able to better detect older adults with mild executive dysfunctions who are at risk for participation declines. Early identification of executive dysfunctions can improve continuity of care and planning of tailored post-discharge rehabilitation services, especially for high-functioning older adults, a mostly overlooked population in acute settings. The results support the use of functional cognition screening measure of medication management ability in acute settings.

“You Need to Set a Daily Schedule”: Understanding Successful Aging via Three-Sided Viewpoints

“…The cognitive domains required for selfmanagement, such as planning, initiation, and problem-solving (i.e., executive functions), are often considered challenging capacities for older adults [7]. Executive function components significantly contribute to the participation levels of older adults [6], and the critical construct of self-management serves as a basis for the engagement with life construct. The third construct, diversity among older adults, leads us to the need to tailor successful aging for each individual.…”

“…The Model of Human Occupation points to the significance of the motivation for occupation (volition), the importance of roles and routines, and the physical and mental abilities that underlie skilled performance [5]. However, aging is accompanied by chronic health conditions and a decline in mental abilities and executive functions, which can significantly affect the participation levels of older adults [6,7]. Therefore, older adults are challenged to face changes in these components as they strive for successful aging.…”