The effect of cognitive impairment on the accuracy of the presenting complaint and discharge instruction comprehension in older emergency department patients.
The effect of cognitive impairment on the accuracy of the presenting complaint and discharge instruction comprehension in older emergency department patients.
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DOI：
10.1016/j.annemergmed.2010.12.002
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发表时间：
2011-06
影响因子：
6.2
通讯作者：
Schnelle, John
中科院分区：
文献类型：
--
作者：
Han, Jin H.;Bryce, Suzanne N.;Ely, Wesley;Kripalani, Sunil;Morandi, Alessandro;Shintani, Ayumi;Jackson, James C.;Storrow, Alan B.;Dittus, Robert S.;Schnelle, John
我们试图确定谵妄和痴呆如何影响老年 ED 患者的 1) 就诊疾病的准确性和 2) 出院指导的理解力。这项横断面研究于 2008 年 5 月至 7 月在学术急诊室进行，研究对象包括 65 岁及以上的非疗养院患者。进行了两次开放式访谈，以评估患者准确提供目前病情的能力以及对急诊出院说明（出院诊断、返回急诊室说明和后续说明）的理解。代理人的病情描述和打印的出院说明分别作为参考标准。患者与参考标准之间的一致性由两名评审员使用 5 分制来确定，范围从 1（不一致性）到 5（完全一致性）。进行比例优势逻辑回归以确定认知障碍是否与提出投诉的准确性和出院指导理解相关。所有模型都根据年龄、健康素养、教育程度、非白人种族和听力障碍进行了调整。 202 名患者参与了目前的疾病分析。与没有认知障碍的患者相比，患有谵妄并伴有痴呆（DSD）的患者在急诊科就诊原因与替代者达成一致的可能性较低（调整后的 POR = 0.20；95%CI：0.09 – 0.43）。 115 名患者参与了出院指导理解分析。 DSD 患者理解出院诊断（调整后的 POR = 0.13；95%CI：0.04 – 0.47）、返回急诊室指导（调整后的 POR = 0.18；95%CI：0.04 – 0.82）和随访指导（调整后的 POR = 0.09；95%CI：0.02 – 0.35）与没有认知障碍的患者相比。 DSD 与老年患者表现疾病的准确性下降以及对 ED 出院说明的理解力下降有关。
We sought to determine how delirium and dementia affect 1) the accuracy of the presenting illness and 2) discharge instruction comprehension in older ED patients. This cross-sectional study was conducted at an academic ED from 5/2008 to 7/2008 and included non-nursing home patients who were 65 years old and older. Two open-ended interviews were performed to assess patients’ ability to accurately provide their presenting illness and comprehension of their ED discharge instructions (discharge diagnosis, return to ED instructions, and follow-up instructions). The surrogates’ version of the presenting illness and printed discharge instructions were the reference standards, respectively. Concordance between the patient and the reference standards were determined by two reviewers using a 5-point scale ranging from 1 (no concordance) to 5 (complete concordance). Proportional odds logistic regression was performed to determine if cognitive impairment was associated with presenting complaint accuracy and discharge instruction comprehension. All models were adjusted for age, health literacy, education, non-white race, and hearing impairment. For the presenting illness analysis, 202 patients participated. Compared with patients without cognitive impairment, those with delirium superimposed on dementia (DSD) had lower odds of agreeing with their surrogates with regard to why they were in the ED (adjusted POR = 0.20; 95%CI: 0.09 – 0.43). For the discharge instruction comprehension analysis, 115 patients participated. Patients with DSD had significantly lower odds of comprehending their discharge diagnosis (adjusted POR = 0.13; 95%CI: 0.04 – 0.47), return to the ED instructions (adjusted POR = 0.18; 95%CI: 0.04 – 0.82), and follow-up instructions (adjusted POR = 0.09; 95%CI: 0.02 – 0.35) compared with patients without cognitive impairment. DSD is associated with decreased accuracy of the older patient’s presenting illness and decreased comprehension of ED discharge instructions.
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影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
6.9
作者：
JORM, AF
通讯作者：
JORM, AF
影响因子：
6.2
作者：
Han, Jin H.;Shintani, Ayumi;Eden, Svetlana;Morandi, Alessandro;Solberg, Laurence M.;Schnelle, John;Dittus, Robert S.;Storrow, Alan B.;Ely, E. Wesley
通讯作者：
Ely, E. Wesley
影响因子：
4
作者：
Iracleous, Panayiotis;Nie, Jason Xin;Upshur, Ross E. G.
通讯作者：
Upshur, Ross E. G.
影响因子：
6.2
作者：
Chin, MH;Jin, L;Friedmann, PD
通讯作者：
Friedmann, PD