The prevalence and impact of undiagnosed cognitive impairment in older vascular surgical patients

Partridge, Judith; Dhesi, Jugdeep; Cross, Jason; Lo, Jessica; Taylor, Peter R.; Bell, Rachel E.; Martin, Finbarr C.; Harari, Danielle

doi:10.1016/j.jvs.2014.04.041

Cited by 107 publications

(110 citation statements)

References 49 publications

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“…Care delivery to patients with dementia in acute hospitals has advanced under the spotlight that was attracted by examples of detrimental care [21, 24]. The evidence shows that cognitive impairments must be actively identified for appropriate management to be undertaken [25–28]. Studies [26, 28, 29] have shown that cognitive impairment is under-detected, and that lack of detection is linked to poorer care.…”

Section: Recognition Of the Needmentioning

confidence: 99%

Optimising care for patients with cognitive impairment and dementia following hip fracture

et al. 2017

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The global shift in demographics towards aging populations is leading to a commensurate increase in age-related disease and frailty. It is essential to optimise health services to meet current needs and prepare for anticipated future demands. This paper explores issues impacting on people living with cognitive impairment and/or dementia who experience a hip fracture and are cared for in acute settings. This is important given the high mortality and morbidity associated with this population. Given the current insufficiency of clear evidence on optimum rehabilitation of this patient group, this paper explored three key themes namely: recognition of cognitive impairment, response by way of training and education of staff to optimise care for this patient group and review of the importance of outcomes measures. Whilst there is currently insufficient evidence to draw conclusions about the optimal ways of caring for patients living with dementia following hip fracture, this paper concludes that future research should improve understanding of healthcare staff education to improve the outcomes for this important group of patients.

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Section: Recognition Of the Needmentioning

confidence: 99%

Optimising care for patients with cognitive impairment and dementia following hip fracture

et al. 2017

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“…In a prospective study using the Montreal Cognitive Assessment (MoCA) test to assess mild CI in elderly patients undergoing elective surgery, Na and Yy demonstrated the prevalence of mild CI to be 56% with an associative increase with age (9). In another prospective study of 114 elderly patients undergoing vascular surgery, Partridge et al showed that 68% of patients met the criteria for CI or dementia (10). Similarly, in a prospective study of 129 elderly patients who underwent lumbar spinal surgery, Lee et al found the prevalence of CI to be 38% using the Mini-Mental Status Examination (1).…”

Section: Discussionmentioning

confidence: 99%

185 The Prevalence of Undiagnosed Pre-Surgical Cognitive Impairment and Its Post-Surgical Clinical Impact in Elderly Patients Undergoing Surgery for Adult Spinal Deformity

Adogwa¹,

Elsamadicy²,

Lydon³

et al. 2017

Neurosurgery

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Background: Pre-existing cognitive impairment (CI) is emerging as a predictor of poor post-operative outcomes in elderly patients. Little is known about impaired preoperative cognition and outcomes after elective spine surgery in this patient population. The purpose of this study was to assess the prevalence of neuro CI in elderly patients undergoing deformity surgery and its impact on postoperative outcomes.Methods: Elderly subjects undergoing elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Pre-operative baseline cognition was assessed using the Saint Louis Mental Status (SLUMS) test. SLUMS consists of 11 questions, which can give a maximum of 30 points. Mild CI was defined as a SLUMS score between 21-26 points, while severe CI was defined as a SLUMS score of ≤20 points. Normal cognition was defined as a SLUMS score of ≥27 points. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between patients with and without baseline CI.Results: Eighty-two subjects were included in this study, with mean age of 73.26±6.08 years. Fiftyseven patients (70%) had impaired cognition at baseline. The impaired cognition group had the following outcomes: increased incidence of one or more postoperative complications (39% vs. 20%), higher incidence of delirium (20% vs. 8%), and higher rate of discharge institutionalization at skilled nursing or acute rehab facilities (54% vs. 30%). The length of hospital stay and 30-day hospital readmission rates were similar between both cohorts (5.33 vs. 5.48 days and 12.28% vs. 12%, respectively).Conclusions: CI is highly prevalent in elderly patients undergoing surgery for adult degenerative scoliosis. Impaired cognition before surgery was associated with higher rates of post-operative delirium, complications, and discharge institutionalization. CI assessments should be considered in the pre-operative evaluations of elderly patients prior to surgery.

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“…However, surgeons have little knowledge of the assessment and management of preoperatively identifiable age-related factors that affect outcomes. Frailty, poor functional status, cognitive impairment and postoperative delirium in older people have all been shown to be associated with prolonged postoperative stay, adverse postoperative outcomes, [13][14][15][16][17] and postoperative discharge to a higher level of care. 18 The prevalence and severity of postoperative complications in an older surgical patient has also been shown to have a negative effect on the time take to return to baseline functional status.…”

Section: Preoperative Carementioning

confidence: 99%

Surgery in the older person: Training needs for the provision of multidisciplinary care

Pearce

Bunni

McCarthy

et al. 2016

annals

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INTRODUCTION Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. METHODS We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. FINDINGS The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine. While 'surgery in childhood' continues to form part of the general surgical higher training syllabus, surgery in the later years of life does not. There are limited postgraduate courses and training opportunities currently available to surgeons in this field. There is clear societal need to address perioperative care for older surgical patients, which has proved successful in some centers. Moreover, surgical trainees support the inclusion of geriatric medicine issues into their training. CONCLUSIONS The ageing population requires a multidisciplinary perioperative approach, with dedicated and appropriately trained clinicians and allied health care professionals to improve outcomes.

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The prevalence and impact of undiagnosed cognitive impairment in older vascular surgical patients

Cited by 107 publications

References 49 publications

Optimising care for patients with cognitive impairment and dementia following hip fracture

Optimising care for patients with cognitive impairment and dementia following hip fracture

185 The Prevalence of Undiagnosed Pre-Surgical Cognitive Impairment and Its Post-Surgical Clinical Impact in Elderly Patients Undergoing Surgery for Adult Spinal Deformity

Surgery in the older person: Training needs for the provision of multidisciplinary care

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