Abstract
BackgroundPrevious studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or single-center study designs. The purpose of our study was to examine the prevalence of cognitive impairment and the relationship between cognitive impairment and 1-year adverse health outcomes in older inpatients.MethodsThis study was a large-scale multi-center cohort study conducted from October 2018 to February 2020. Six tertiary hospitals across China were selected using a two-stage cluster sampling method, and eligible older inpatients were selected for the baseline survey and follow-up. The Mini Cognitive Scale and the FRAIL scale were used to screen for cognitive impairment and frailty, respectively. The EuroQol-5 Dimension-5 Level questionnaire was used to assess health-related quality of life (HRQoL). We used a generalized estimating model to evaluate the relationship between cognitive impairment and adverse outcomes.ResultsThe study included 5008 men (58.02%) and 3623 women (41.98%), and 70.64% were aged 65–75 years, and 26.27% were aged 75–85 years. Cognitive impairment was observed in 1756 patients (20.35%). There were significant differences between participants with cognitive impairment and those with normal cognitive function for age, gender, surgery status, frailty, depression, handgrip strength and so on. After adjusting for multiple covariates, compared with patients with normal cognitive function, the odds ratio for 1-year mortality was 1.216 (95% confidence interval [CI]: 1.076–1.375) and for 1-year incidence of frailty was 1.195 (95% CI: 1.037–1.376) in patients with cognitive impairment. Similarly, the regression coefficient of 1-year HRQoL was − 0.013 (95% CI: − 0.024−− 0.002). In the stratified analysis, risk of adverse outcome within 1 year was higher in older patients with cognitive impairment aged over 75 years than those aged 65–74 years.ConclusionsWe revealed that cognitive impairment was highly correlated with occurrence of 1-year adverse health outcomes (death, frailty, and decreased HRQoL) in older inpatients, which provides a basis for formulating effective intervention measures.Trial registrationChinese Clinical Trial Registry, ChiCTR1800017682, registered 09 August 2018.
Highlights
Previous studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or singlecenter study designs
We revealed that cognitive impairment was highly correlated with occurrence of 1-year adverse health outcomes in older inpatients, which provides a basis for formulating effective intervention measures
For body mass index (BMI), 48.6% of patients fell in the normal range, and 34.6% of patients were in the Characteristics Sample size Age 65–74 75–84 ≥ 85 BMI Underweight Normal weight Overweight Obese Gender female male Ethnicity Han Others Education illiterate Primary school Middle school University Frailty Frail Pre-frail Robust Surgery No Yes Marital status Married Divorced or widowed Smoking status Current smoker Former smoker Non-smoker Drinking Current drinker Former drinker Non-drinker Long-time bedridden No Yes Falls No Yes Handgrip strength low-level Normal
Summary
Previous studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or singlecenter study designs. The purpose of our study was to examine the prevalence of cognitive impairment and the relationship between cognitive impairment and 1-year adverse health outcomes in older inpatients. The cognitive function of the patients is lower than the general level of their peers, but it has no significant effect on activities of daily living (ADL). It is a transitional stage between normal cognition and dementia, and the annual rate of progression to Alzheimer’s disease is 18% [4]. The reduction in cognitive ability and dependence on nursing are long-term issues for patients and caregivers, which impose a significant burden on families and society [6]
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