Browsing by Author "Cheng, Chia-Min"

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Cognitive stimulation during hospitalization improves global cognition of older Taiwanese undergoing elective total knee and hip replacement surgery
(2012-06-01)
Cheng, Chia-Min
;
Chiu, Ming-Jang
;
Wang, Jyh-Horng
;
Liu, Hwa-Chang
;
Shyu, Yea-Ing Lotus
cheng c.-m., chiu m.-j., wang j.-h., liu h.-c., shyu y.-i.l., huang g.-h. & chen c.c.-h. (2012) Cognitive stimulation during hospitalization improves global cognition of older Taiwanese undergoing elective total knee and hip replacement surgery. Journal of Advanced Nursing68(6), 1322-1329. Abstract Aim. This article is a report on a pilot study conducted to determine the effects of cognitively stimulating activities in older patients undergoing elective hip and/or knee replacement. Background. Cognitive decline occurs in 16-35.5% of older hospitalized patients. In-hospital interventions, such as cognitively stimulating activities, might combat cognitive decline. However, evidence supporting such interventions is limited. Methods. For this randomized pilot trial, 50 older patients (90% women with a mean age of 72.8 years) were recruited in 2008 from a tertiary medical centre in Taiwan. While hospitalized, participants in the intervention group received a daily nurse-led, individual-based, cognitive-stimulation intervention. The comparison group received usual care. Cognitive function was assessed using Mini-Mental State Examination at admission, discharge and 1 month after discharge. Results. The incidence of cognitive decline (=2-point decline in cognitive score) by hospital discharge was significantly lower for the intervention group (12%) than the usual care group (44%). The intervention group also had better cognitive scores following hospitalization. Upon discharge, participants in the intervention group scored 1.28 points higher than at admission, whereas participants in the usual care declined by 0.76 points. Improvement in cognitive status persisted for the intervention group (+1.33 points) vs. usual care (-0.26 points) at 1 month after discharge. Group differences in changes were statistically significant both at discharge and 1 month afterwards. Conclusion. Our cognitive-stimulation intervention benefited global cognitive function among older patients undergoing elective hip and/or knee replacement. The benefit persisted at 1 month after discharge.
Patterns of cognitive change in elderly patients during and 6 months after hospitalisation: A prospective cohort study
(2011-03-01)
Chen, Cheryl Chia-Hui
;
Chiu, Ming-Jang
;
Chen, Sui-Pi
;
Cheng, Chia-Min
;
Huang, Guan-Hua
Background: The extent and patterns of cognitive change regularly occurring in elderly patients who experience prolonged hospitalisation have not been well examined. Objective: To describe patterns of cognitive change during and 6 months after hospitalisation and to identify prognostic factors associated with different patterns of changes. Design: A prospective cohort study. Setting: Five med-surgical units at a tertiary hospital in Taipei, Taiwan. Participants: Patients >= 65 years old without preexisting profound cognitive impairment (Mini-Mental State Examination score >= 20) and with an expected hospital length of stay >5 days were drawn from consecutive admissions. Of 351 patients, 82.9% (138 women, 153 men, mean age = 71.6 years) completed all four scheduled assessments. Methods: Cognition was measured by the Mini-Mental State Examination at 4 times: admission, discharge, and 3 and 6 months post-discharge. Possible prognostic factors at admission included demographics, comorbidities, number of medications, serum haemoglobin, length of hospital stay, and surgery. Results: Four cognitive-change patterns with a high prevalence of decline were identified by cluster analysis. The worsening then improve group (n = 47) had a deep V-shape with a mean fluctuation of 3.9 points on the Mini-Mental State Examination, and the low continuous group (n = 83) had little change. Both the start high and decline (n = 66) and start low and decline (n = 95) groups showed persistent and accelerated declines, with baseline cognitive scores of 29.1 and 25.5 points, respectively. Predictor variables at admission for different patterns of cognitive change were age, total education (years), cardiovascular comorbidities, number of medications, functional and nutritional status, depressive symptoms, surgical treatment, and haemoglobin level <12 g/dL. Conclusions: Cognitive decline during and after hospitalisation shows four heterogeneous patterns of change. Different patterns of change were predicted by age, education, cardiovascular comorbidities, number of medications, functional and nutritional status, depressive symptoms, surgical treatment, and haemoglobin level <12 g/dL, most of which are potentially modifiable factors. (C) 2010 Elsevier Ltd. All rights reserved.