Is cognitive function a concern in independent elderly adults discharged home from the emergency department in Canada after a minor injury?

Marie-Christine Ouellet, Marie-Josée Sirois, Simon Beaulieu-Bonneau, Jacques Morin, Jeffrey Perry, Raoul Daoust, Laura Wilding, Véronique Provencher, Stéphanie Camden, Nadine Allain-Boulé, Marcel Émond
Journal of the American Geriatrics Society 2014, 62 (11): 2130-5

OBJECTIVES: To describe the cognitive functioning of independent community-dwelling elderly adults visiting the emergency department (ED) for minor injuries and at 3- and 6-month follow-up assessments and to document the occurrence of falls, return to the ED, and hospital visits over time according to cognitive level.

DESIGN: Prospective cohort study.

SETTING: Three Canadian EDs.

PARTICIPANTS: Individuals aged 65 and older who were independent in basic activities of daily living, visiting the ED for minor injuries, and discharged home within 48 hours (N = 320).

MEASUREMENTS: Participants completed the Montreal Cognitive Assessment (MoCA). New falls involving pain and ED or hospital visits were documented at 3 and 6 months.

RESULTS: At baseline, 62.4% of participants scored below the recommended cutoff of 26 on the MoCA, suggesting cognitive dysfunction, and 22.9% scored below a more-stringent cutoff of 21. MoCA scores had improved significantly at 3 and 6 months. Items showing the most improvement were delayed recall and verbal fluency. Persons with MoCA scores of less than 21 reported significantly more new falls and hospital visits 3 to 6 months after injury.

CONCLUSION: Cognition is not optimal in many community-dwelling elderly adults visiting an ED for a minor injury, which may affect their capacity to comprehend, recall, and adhere to medical recommendations after their injury and put them at risk of further negative health events such as falls.

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