Persistent cognitive decline in older hospitalized patients in Taiwan

Aim.: This paper is a report of a study conducted to determine the prevalence and predictors of persistent and transient cognitive decline in older hospitalized patients over 6 months after hospital discharge. Background.: Cognitive decline occurs in 16-35·5% of older hospitalized patients, but this decline may be persistent rather than transient. Distinguishing persistent from transient cognitive decline is clinically useful. Methods.: For this prospective cohort study, 291 older patients were recruited from five medical and surgical units at a tertiary medical centre in Taiwan between 2004 and 2006. Participants were assessed for cognitive status by scores on the Mini-Mental State Examination at admission, discharge, 3 and 6 months postdischarge. Persistent cognitive decline was defined as continuing score reduction and ≥3-point reduction 6 months postdischarge. Transient decline was defined as ≥3-point reduction at some stage, with a total decline <3 points 6 months postdischarge. Findings.: The cognitive status of the majority of participants (57·4%, n = 167) decreased ≥3 points during follow-up. Of these decliners, 59 (35·3%) had persistent cognitive decline, with an average 5·32-point reduction 6 months postdischarge. Forty-six (27·5%) participants experienced transient cognitive decline. After multiple adjustments in logistic regression analysis, persistent decline was predicted by no in-hospital functional decline (OR = 0·16, P = 0·002), more re-admissions after discharge (OR = 2·42, P = 0·020), and older age (OR = 1·09, P = 0·048). Conclusion.: A new perspective is needed on discharge planning on patients at risk for persistent cognitive decline. Nurses can oversee the delivery of care, identify cognitive decline, refer patients, and educate families on strategies to enhance cognitive functioning for their aging relatives.