Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-13T04:14:26.888Z Has data issue: false hasContentIssue false
  • English
  • Français

Correlates of cognitive functioning in independent elderly patients discharged home from the emergency department after a minor injury

Published online by Cambridge University Press:  25 April 2016

Marie-Christine Ouellet ,
Marie-Josée Sirois ,
Simon Beaulieu-Bonneau Open the ORCID record for Simon Beaulieu-Bonneau [Opens in a new window] ,
Marie-Ève Gagné ,
Jacques Morin ,
Jeffrey Perry ,
Raoul Daoust ,
Laura Wilding ,
Véronique Provencher  and
Stéphanie Camden
...Show all authors
Marie-Christine Ouellet*
Affiliation:
Centre de recherche du CHU de Québec, Québec, QC, Canada Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada École de psychologie, Université Laval, Québec, QC, Canada
Marie-Josée Sirois
Affiliation:
Centre de recherche du CHU de Québec, Québec, QC, Canada Département de réadaptation, Université Laval, Québec, QC, Canada
Simon Beaulieu-Bonneau
Affiliation:
Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada École de psychologie, Université Laval, Québec, QC, Canada
Marie-Ève Gagné
Affiliation:
Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada École de psychologie, Université Laval, Québec, QC, Canada
Jacques Morin
Affiliation:
Centre de recherche du CHU de Québec, Québec, QC, Canada
Jeffrey Perry
Affiliation:
The Ottawa Hospital, Ottawa, ON, Canada Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
Raoul Daoust
Affiliation:
Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada Département de médecine de famille et médecine d'urgence, Université de Montréal, Montréal, QC, Canada
Laura Wilding
Affiliation:
The Ottawa Hospital, Ottawa, ON, Canada
Véronique Provencher
Affiliation:
Département de réadaptation, Université Laval, Québec, QC, Canada
Stéphanie Camden
Affiliation:
Centre de recherche du CHU de Québec, Québec, QC, Canada
Nadine Allain-Boulé
Affiliation:
Centre de recherche du CHU de Québec, Québec, QC, Canada
Marcel Émond
Affiliation:
Centre de recherche du CHU de Québec, Québec, QC, Canada Département de Médecine Familiale et de Médecine d'urgence, Université Laval, Québec, QC, Canada
*
Correspondence should be addressed to: Marie-Christine Ouellet PhD, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Institut de réadaptation en déficience physique de Québec, 525 boulevard Hamel, Québec, QC, G1M 2S8, Canada. Phone: +418-529-9141, Fax: +418-529-3548. Email: marie-christine.ouellet@psy.ulaval.ca.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The objective of this study was to explore correlates of cognitive functioning of older adults visiting the emergency department (ED) after a minor injury.

Methods:

These results are derived from a large prospective study in three Canadian EDs. Participants were aged ≥ 65 years and independent in basic activities of daily living, visiting the ED for minor injuries and discharged home within 48 hours (those with known dementia, confusion, and delirium were excluded). They completed the Montreal Cognitive Assessment (MoCA). Potential correlates included sociodemographic and injury variables, and measures of psychological and physical health, social support, mobility, falls, and functional status.

Results:

Multivariate analyses revealed that male sex, age ≥ 85 years, higher depression scores, slower walking speed, and self-reported memory problems were significantly associated with lower baseline MoCA scores.

Conclusions:

These characteristics could help ED professionals identify patients who might need additional cognitive evaluations or follow-ups after their passage through the ED. Obtaining information on these characteristics is potentially feasible in the ED context and could help professionals alter favorably elderly's trajectory of care. Since a significant proportion of elderly patients consulting at an ED have cognitive impairment, the ED is an opportunity to prevent functional and cognitive decline.

Keywords

minor injurycognitive statusemergency medicinegeriatricsMontreal Cognitive Assessment
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 8 , August 2016 , pp. 1313 - 1322
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Audet, N., Lemieux, M. and Cardin, J.-F. (2001). Enquête Sociale et de santé 1998 - Cahier Technique et Méthodologique: Définitions et Composition des Indices. Montréal, QC: Institut de la statistique du Québec, Direction Santé Québec.Google Scholar
Ayan, C., Cancela, J. M., Gutierrez, A. and Prieto, I. (2013). Influence of the cognitive impairment level on the performance of the timed “Up & Go” test (TUG) in elderly institutionalized people. Archives of Gerontology and Geriatrics, 56, 44–49.Google Scholar
Canadian Study of Health and Aging Working Group (1994). Canadian study of health and aging: study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899–913.Google Scholar
Do, M. T., Chang, V. C., Kuran, N. and Thompson, W. (2015). Fall-related injuries among Canadian seniors, 2005–2013: an analysis of the Canadian community health survey. Health Promot Chronic Dis Prev Can, 35, 99–108.Google Scholar
Duda, B., Puente, A. N. and Miller, L. S. (2014). Cognitive reserve moderates relation between global cognition and functional status in older adults. Journal of Clinical and Experimental Neuropsychology, 36, 368–378.Google Scholar
Fillenbaum, G. (1978). Multidimensional Functional Assessment: The OARS Methodology – A Manual. Durham, NC: Center for the Study of Aging and Human Development, Duke University.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Han, J. H. et al. (2011). The effect of cognitive impairment on the accuracy of the presenting complaint and discharge instruction comprehension in older emergency department patients. Annals of Emergency Medicine, 57, 662–671, e662.Google Scholar
Hedeker, D., Gibbons, R. D. and Flay, B. R. (1994). Random-effects regression models for clustered data with an example from smoking prevention research. Journal of Consulting and Clinical Psychology, 62, 757–765.Google Scholar
Hill, K. D., Schwarz, J. A., Kalogeropoulos, A. J. and Gibson, S. J. (1996). Fear of falling revisited. Archives of Physical Medicine and Rehabilitation, 77, 1025–1029.Google Scholar
Hill, K. D. and Stinson, A. T. (2004). A pilot study of falls, fear of falling, activity levels and fall prevention actions in older people with polio. Aging Clinical and Experimental Research, 16, 126–131.Google Scholar
Hustey, F. M. and Meldon, S. W. (2002). The prevalence and documentation of impaired mental status in elderly emergency department patients. Annals of Emergency Medicine, 39, 248–253.Google Scholar
Hustey, F. M., Meldon, S. W., Smith, M. D. and Lex, C. K. (2003). The effect of mental status screening on the care of elderly emergency department patients. Annals of Emergency Medicine, 41, 678–684.CrossRefGoogle ScholarPubMed
Latham, L. P. and Ackroyd-Stolarz, S. (2014). Emergency department utilization by older adults: a descriptive study. Canadian Geriatrics Journal, 17, 118–125.Google Scholar
Lee, J. et al. (2015). Return to the ED and hospitalisation following minor injuries among older persons treated in the emergency department: predictors among independent seniors within 6 months. Age and Ageing, 44, 624–629.Google Scholar
Li, R. and Singh, M. (2014). Sex differences in cognitive impairment and Alzheimer's disease. Frontiers in Neuroendocrinology, 35, 385–403.Google Scholar
McCusker, J., Bellavance, F., Cardin, S., Trepanier, S., Verdon, J. and Ardman, O. (1999). Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. Journal of the American Geriatrics Society, 47, 1229–1237.Google Scholar
Molnar, F. J., Wells, G. A. and McDowell, I. (2008). The derivation and validation of the Ottawa 3D and Ottawa 3DY three- and four-question screens for cognitive impairment. Clinical Medicine Insights: Geriatrics, 2, 1–11.Google Scholar
Muir, S. W., Gopaul, K. and Montero Odasso, M. M. (2012). The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age and Ageing, 41, 299–308.Google Scholar
Nasreddine, Z. S. et al. (2005). The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699.Google Scholar
Ouellet, M. C. et al. (2014). Is cognitive function a concern in independent elderly adults discharged home from the emergency department in Canada after a minor injury? Journal of the American Geriatrics Society, 62, 2130–2135.Google Scholar
Plassman, B. L., Williams, J. W. Jr., Burke, J. R., Holsinger, T. and Benjamin, S. (2010). Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Annals of Internal Medicine, 153, 182–193.Google Scholar
Podsiadlo, D. and Richardson, S. (1991). The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142–148.Google Scholar
Rossetti, H. C., Lacritz, L. H., Cullum, C. M. and Weiner, M. F. (2011). Normative data for the Montreal cognitive assessment (MoCA) in a population-based sample. Neurology, 77, 1272–1275.Google Scholar
Russell, M. A., Hill, K. D., Blackberry, I., Day, L. L. and Dharmage, S. C. (2006). Falls risk and functional decline in older fallers discharged directly from emergency departments. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 61, 1090–1095.CrossRefGoogle ScholarPubMed
Salvi, F., Morichi, V., Grilli, A., Giorgi, R., De Tommaso, G. and Dessi-Fulgheri, P. (2007). The elderly in the emergency department: a critical review of problems and solutions. Internal and Emergency Medicine, 2, 292–301. Epub 2007 Nov 2028.CrossRefGoogle ScholarPubMed
Scott, V., Pearce, M. and Pengelly, C. (2005). Technical report: injury resulting from falls among Canadians age 65 and over. On the Analysis of Data from the Canadian Community Health Survey, Cycle 2.1 As Presented in Report on Seniors' Falls in Canada. Ottawa, Ontario: Public Health Agency of Canada.Google Scholar
Shah, M. N., Jones, C. M., Richardson, T. M., Conwell, Y., Katz, P. and Schneider, S. M. (2011). Prevalence of depression and cognitive impairment in older adult emergency medical services patients. Prehospital Emergency Care, 15, 4–11.Google Scholar
Sirois, M. J. et al. (2013). Cumulative incidence of functional decline after minor injuries in previously independent older Canadian individuals in the emergency department. Journal of the American Geriatrics Society, 61, 1661–1668.Google Scholar
Terrell, K. M., Hustey, F. M., Hwang, U., Gerson, L. W., Wenger, N. S. and Miller, D. K. (2009). Quality indicators for geriatric emergency care. Academic Emergency Medicine, 16, 441–449.Google Scholar
Waldron-Perrine, B. and Axelrod, B. N. (2012). Determining an appropriate cutting score for indication of impairment on the Montreal cognitive assessment. International Journal of Geriatric Psychiatry, 27, 1189–1194.Google Scholar
Zigmond, A. S. and Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar