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Feasibility and utility of a cognitive screening for risk stratification in hospitalized older patients.
Int J Geriatr Psychiatry. 2018 Dec 26;:
Authors: Geschke K, Weyer-Elberich V, Mueller AK, Binder H, Fellgiebel A
Abstract
OBJECTIVES: To determine whether the Mini-Cog can be applied by nursing staff to hospitalized elderly patients for cognitive impairment associated risk stratification.
METHODS: This explorative prospective multicenter cohort study was carried out among 2522 patients aged 70 and older, hospitalized due to physical illness in eight hospitals in Rhineland-Palatinate, Germany. All patients were asked to conduct the Mini-Cog at the day of admission and were clustered into low-, intermediate-, and good-performance categories by trained nursing staff and two experienced geronto-psychiatrists as gold standard. Complications in the course of the treatment were monitored.
RESULTS: The Mini-Cog was conducted in 1398 (54%) out of 2522 eligible patients. Mini-Cog scores assessed by nursing staff differed from the gold standard in 327 cases (23.9%). According to the Area under the Curve (AUC), nursing staff identified cognitively low-performing patients almost as well as the geronto-psychiatrists (AUC 0.862, 95%-CI 0.83 to 0.89; p<.001, accuracy 89.6%). Overall, 241 (17.6%) patients were classified as low-performing. These patients had a significantly higher probability of suffering from at least one complication (odds ratio OR=3.13; 95%-CI 2.09 to 4.70; calculated by a logistic regression model, adjusted for age), and they had a higher probability to show behavioral symptoms.
CONCLUSION: Even under naturalistic conditions, nursing staff detected cognitively low-performing inpatients with the Mini-Cog. Using this short screening instrument should enable to predict complications of hospitalized older patients associated with cognitive impairment, a precondition to implement targeted care for this vulnerable patient group.
PMID: 30588672 [PubMed - as supplied by publisher]