DETECTING COGNITIVE IMPAIRMENT AFTER HIP FRACTURE TO PREDICT DEMENTIA-RELATED CAUSE OF DEATH. (11th November 2018)

• Record Type: Journal Article
• Authors: Mutchie, H; Orwig, D; Hochberg, M; Magaziner, J; Gruber-Baldini, A
• Is Part Of: Innovation in aging. Volume 2(2018)Supplement 1
• Page Start: 137
• Page End: 138
• Publication Date: 2018-11-11
• Subjects: Aging -- Periodicals; Gerontology -- Periodicals; 612.67
• DOI: 10.1093/geroni/igy023.501
• Languages: English
• ISSNs: 2399-5300

Abstract

Abstract: Hip fracture patients have high rates of pre-existing dementia(20%) and post-operative delirium(35–61%), which are predictive of overall mortality after fracture. The purpose of this study was to examine the predictive value of Modified Mini-Mental State Examination(3MS) and chart diagnoses of dementia at hospital discharge on dementia-related cause of death(DR-COD) in a cohort of hip fracture patients. Hospital charts, cognitive testing within 15 days of admission, and National Death Index reports from the Baltimore Hip Studies 7th cohort(2006–2011) were collected in 339(171 women, 168 men) subjects. The 204 subjects that died before 2015 were analyzed using odds(OR) of DR-COD, which included codes of Alzheimer's disease or dementia as any primary or contributing cause of death. Predictors included dementia or delirium diagnosis in hospital chart, and age/education-corrected 3MS<78. Cognitive impairment was found in 13.7%(n=28) by both 3MS and chart; 13.7%(n=28) by 3MS alone, 12.8%(n=26) by chart alone (with 59.8% not impaired). DR-COD was found in 29.7% of deceased participants(n=47). Those with cognitive impairment by both 3MS and chart had greater DR-COD(OR=11.6, 95%CI:4.52–29.71, p=<.001) and shorter survival times (M=24.67 + 4.15) than those identified by neither (ref OR=1, M=64.91 + 2.3). Odds of DR-COD among those identified by 3MS alone were 5.1(95%CI:2.54–10.30); 4.3 by chart alone(95%CI:2.15–8.66). Survival times for 3MS or charts are largely the same (M=46.35 + 5.4 vs. M=45.83 + 5.7), surviving shorter than no impairment(p<.0001). 3MS alone detected impairment in 19.2% of patients who later died of DR-COD. The addition of measuring 3MS within 15 days of admission improves the prediction of DR-COD compared to chart diagnosis of dementia alone.