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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Cognitive impairment influences perioperative quality of life in older surgical patients: A multicenter longitudinal
Ellene Yan1, Jessica Xiong2, Monica Yuen2
1Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Background:
The impact of cognitive impairment (CI) on perioperative quality of life (QoL) in older surgical patients remains under-explored. We compared longitudinal QoL trajectories by CI status and examined associations between preoperative QoL and postoperative outcomes.
Methods:
Patients aged ≥65 years undergoing elective non-cardiac surgery at two academic hospitals were assessed for preoperative CI using the Ascertain Dementia 8-Item Questionnaire (AD8), Montreal Cognitive Assessment (MoCA), and Mini-Cog. QoL was measured preoperatively and at 30 and 90 days postoperatively using a 0-100 visual analogue scale (VAS). QoL trajectories were analyzed using linear mixed-effects models, with time and cognitive status as covariates.
Results:
Among 370 participants (median age 73 years [IQR: 69-77]; 58% female), 292 and 289 participants completed 30- and 90-day follow-up, respectively. Compared to those without AD8-defined CI (CIAD8), participants with CIAD8 reported significantly lower QoL preoperatively (67 ± 3 vs. 78 ± 1, P < 0.001) and postoperatively at 30 days (59 ± 3 vs. 75 ± 1, P < 0.001) and 90 days (60 ± 3 vs. 77 ± 1, P < 0.001). Lower preoperative QoL was associated with greater all-cause complications, non-home discharge, and composite adverse outcomes within 30 days, as well as composite adverse outcomes at 90 days. Higher pain, frailty, anxiety/depression, and CIAD8 remained independently associated with lower perioperative QoL.
Conclusion:
Older patients with CIAD8 experienced persistently lower QoL throughout the perioperative period, compared to those without CIAD8. Although QoL transiently declined within the CIAD8 group at 30 days, longitudinal QoL trajectories did not differ significantly between participants with and without CIAD8. Brief preoperative screening of CI and QoL may nevertheless help identify patients at risk of poor QoL and adverse postoperative outcomes.
