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Saturday 16 December 2017
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Presurgical Cognitive Screening Could Prevent Complications In Elderly Patients

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New research from the Harvard Medical School in Boston shows screening elderly patients for cognitive impairment prior to surgery may catch undiagnosed problems.

The research team conducted preoperative screening in a study of 211 patients over the age of 65 having orthopedic surgeries. According to the study’s findings, up to one-quarter of the studied patients showed a likelihood of cognitive impairment.

Cognitive impairment, such as undiagnosed dementia, can raise the risk of postoperative complications. These complications include longer hospital stays, being discharged somewhere other than the patient’s home, and postoperative delirium.

“We really don’t do enough in the preoperative space to look at impairment and frailty in geriatric patients,” said the study’s lead author Dr. Deborah Culley of Harvard Medical School. “We may test mobility, but we need more subtle measures of the brain.”

The majority of surgical centers in the U.S. will test an elderly patient for physical problems prior to surgery to minimize the risk of postsurgical complications. However, surgical centers are now beginning to assess brain function prior to surgery as well.

Preoperative cognitive testing is especially important for those who have no history of dementia. Those who have dementia are more likely to experience postoperative delirium.

“When you talk with a patient before surgery,” said Culley to Reuters Health, “you can notice an impairment in this stressful environment. It’s essentially a cognitive stress test.”

The effects of acute stress may help medical professionals identify cognitive impairments in older patients. For instance, up to 48% younger Americans who don’t take sanity breaks at work are more likely to experience stress at home related to mood changes. Older Americans, on the other hand, are less adaptable, which makes the physical signs of cognitive impairment easier to identify.

The patients in the study were screened at Brigham and Women’s Hospital in Boston by Culley and her team using the Mini-Cog test. The Mini-Cog test is a memory recall test involving three items and has a five-point score.

Culley defined those who received a score of 2 or lower as likely cognitively impaired. The research team then analyzed in-house medical complications after the patients’ surgeries.

The results of the study found 24% of the patients scored a 2 or lower on the Mini-Cog test. These same patients were also up to 37% more likely to have a longer hospital stay and four times more likely to experience postoperative delirium and confusion.

“What’s novel about this is we’re looking at the brain now,” said Dr. Thomas Robinson. Robinson is a professor at the University of Colorado Anschutz Medical Campus in Denver. “Medications have been closely associated with mental function after surgery.”

Older patients have long experienced different risk factors than younger patients in both postsurgical situations and everyday situations. For instance,86% of people living in the state of Florida use central air conditioning, many of whom are over the age of 65. This is because the elderly are more susceptible to heat-related illnesses.

Seniors are also more likely to experience severe symptoms of the common cold, which can last between 48 hours to 14 days, and are five times more likely to need heated humidification for CPAP machines than those under the age of 60.

However, Culley and her team’s research are pointing medical professionals in a new direction. Robinson says future studies may involve measuring cognitive impairment in patients to create postoperative recovery instructions that are personalized to the patient.

“With this screening tool, a daughter of an older patient with some cognitive impairment, for example, could know the likelihood of her parent going home and the higher risk of developing delirium,” said Culley. “A change could be as simple as making sure she’s in the recovery room after surgery to reorient the patient better.”