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Cognitive status predicts preoperative instruction compliance.

Yasuko Mano1, Porus Mistry1, Khoa Tran1

  • 1Department of Anesthesiology, Keck Medical Center, University of Southern California, Los Angeles, CA, United States.

Frontiers in Aging Neuroscience
|February 13, 2023
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Summary

Older adults with cognitive impairment struggle to follow preoperative instructions, increasing complication risks. Tailored care plans and improved instructions significantly reduced this compliance gap, improving outcomes.

Keywords:
geriatric surgical careperioperative brain healthperioperative neurocognitive disorderquality improvementsurgery and aging

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Area of Science:

  • Geriatric Medicine
  • Neuroscience
  • Surgical Patient Care

Background:

  • Perioperative neurocognitive disorder (PNCD) is a common complication in older adults.
  • Preoperative cognitive impairment is the primary risk factor for PNCD and predicts other postoperative complications.
  • Adherence to perioperative instructions may be a modifiable factor influencing patient outcomes.

Purpose of the Study:

  • To investigate if cognitive impairment reduces adherence to preoperative instructions in older surgical patients.
  • To identify barriers to instruction compliance in this population.
  • To implement and evaluate a tailored care plan to improve adherence and reduce outcome disparities.

Main Methods:

  • Routine Mini-Cog screening identified patients aged 65+ at risk for cognitive impairment.
  • Standardized preoperative instructions were given, followed by post-administration surveys on compliance (nil per os, chlorhexidine wipes, medication).
  • Data was stratified by cognitive status; patient/family feedback informed care plan adjustments.

Main Results:

  • Patients with cognitive impairment were significantly more likely to incorrectly follow instructions (OR=10.5, p=0.001).
  • 68% of unimpaired patients followed instructions correctly, compared to only 15.8% of impaired patients (84.2% struggled with ≥1 instruction).
  • Post-intervention, the compliance gap between impaired and unimpaired patients was significantly reduced.

Conclusions:

  • Cognitive status significantly impacts adherence to critical preoperative instructions in older surgical patients.
  • Improving instruction clarity and providing targeted support for cognitively impaired patients can enhance compliance.
  • Addressing instruction adherence is a potential strategy to mitigate outcome disparities in this vulnerable population.