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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
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.
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.
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