Cognitive impairment may be associated with functional outcomes in geriatric orthopedic patients
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Cognitive impairment among geriatric orthopedic patients admitted to rehabilitation may be associated with discharge destination, functional outcomes and length of stay, according to published results.
Researchers performed a retrospective audit of 116 patients older than 65 years of age who were admitted to the general rehabilitation unit at a metropolitan hospital in Brisbane, Queensland, Australia, with the diagnosis of an orthopedic injury and surgery and who were assessed with the Montreal Cognitive Assessment, the functional independence measure score and the modified Barthel Index. Researchers also recorded demographic and clinical information, including age, length of stay and diagnosis.
Diagnostic groups in the study included 44 patients with femoral neck fractures, 42 patients who underwent elective surgery and 30 patients who had other orthopedic conditions, according to results. Researchers found 71.55% of patients had cognitive impairment with a median mild cognitive impairment across all diagnoses.
Post hoc analysis results showed patients who underwent elective surgery had significantly higher functional independent measure cognitive scores at admission vs. patients with femoral neck fractures. The Kruskal-Wallis test also showed a difference in functional independent measure cognitive scores at discharge between patients with femoral neck fractures and patients who underwent elective surgery. Researchers noted patients who underwent elective orthopedic procedures had significantly higher functional independent measure motor scores compared with patients with femoral neck fractures and those who underwent other orthopedic procedures both at admission and discharge.
Results showed patients who underwent elective surgery had significantly higher modified Barthel Index scores at admission vs. patients with femoral neck fractures and other orthopedic procedures. However, researchers only found a difference of modified Barthel Index scores at discharge between patients who underwent elective orthopedic surgery and patients with femoral neck fractures. Measures of cognition for the Montreal Cognitive Assessment and functional independence measure scores had a significant association with length of stay, function and discharge destination, according to results.
As patients with moderate-severe cognition impairment may have potential functional gain with rehabilitation, the authors noted that further research is needed in the ability to design rehabilitation programs to maximize functional outcomes for older patients with cognitive changes.
“Additionally, with falls being the leading cause of orthopedic injury in older people, fall prevention programs, which include an education component, need to consider cognitive factors to maximize their effectiveness in reducing the preventing falls,” the authors wrote. “Although cognitive retraining and interventions are typically undertaken with neurological patients, it is important to consider addressing the age-related deficits, particularly in the area of cognition with geriatric orthopedic patients to assist with improving functional outcomes and length of stay.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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