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Cognitive stimulation during hospitalization improves global cognition of older Taiwanese undergoing elective total knee and hip replacement surgery

Authors

  • Chia-Min Cheng,

    1. Chia-Min Cheng MSN RN
      School Nurse
      Simes Elementary School, Taoyuan, Taiwan
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  • Ming-Jang Chiu,

    1. Ming-Jang Chiu MD PhD
      Associate Professor
      Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Jyh-Horng Wang,

    1. Jyh-Horng Wang MD PhD
      Associate Professor
      Department of Orthopaedics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Hwa-Chang Liu,

    1. Hwa-Chang Liu MD PhD
      Professor Emeritus
      Department of Orthopaedics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Yea-Ing Lotus Shyu,

    1. Yea-Ing Lotus Shyu PhD RN
      Professor
      Chang Gung University, Graduate School of Nursing, Taoyuan, Taiwan
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  • Guan-Hua Huang,

    1. Guan-Hua Huang PhD
      Associate Professor
      Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
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  • Cheryl Chia-Hui Chen

    1. Cheryl Chia-Hui Chen RN DNSc
      Associate Professor
      Department of Nursing, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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C.C.-H. Chen:
e-mail: cherylchen@ntu.edu.tw

Abstract

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.

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