942 THE POST-OPERATIVE RISKS OF STOMA FORMATION IN THE COGNITIVELY IMPAIRED

• Published in: Age and ageing 2022-06, Vol.51 (Supplement_2)
• Main Author: Jarratt-Barnham, I
• Format: Article
• Language: English
• Subjects: Cognitive ability; Cognitive impairment; Complications; Dementia; Dementia disorders; Home health care; Literature reviews; Nursing homes; Older people; Ostomy; Patient admissions; Patients; Psychological distress; Quantitative analysis; Stoma care; Suitability; Surgery; Surveillance
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afac126.010

Abstract Introduction Over 20,000 stomas are formed in the UK annually, many for geriatric patients. However, formation both requires significant surgical intervention and leaves patients with the substantial post-operative burden of stoma care. Such is this care’s complexity, 70% of all stoma patients experience complication. Patients with cognitive impairment may be at particular risk of poor outcomes following stoma formation. However, the impact of cognitive impairment on patient suitability for stoma formation is under-discussed in the literature. We conducted a preliminary literature review to identify factors for to be considered when proposing stoma formation in this patient group. Method A preliminary literature review searching several databases (PubMed, Cochrane and Embase) was conducted using pre-devised search terms. A further manual search was then performed reviewing the references of identified papers of interest. Arguments relevant to stoma formation in elderly patients with cognitive impairment were extracted. Results Little quantitative evidence surrounding stoma formation in the cognitively impaired was found. However, four key risks for these patients were identified: 1) Patients with cognitive impairment, particularly dementia, experience higher rates of perioperative complication following surgery. 2) Cognitively impaired patients are at increased risk of post-operative stoma complications, precipitated by poor stoma care. These complications are also more likely to be uncommonly advanced on presentation due to poor patient surveillance. 3) The need for regular stoma care can necessitate unwanted nursing home admission. 4) Cognitively impaired patients are particularly vulnerable to psychological distress following stoma formation due to reduced ability to adapt to and participate in their stoma’s care. Conclusion This preliminary review identified several factors to be considered when determining suitability for stoma formation in a cognitively impaired patient. However, little quantitative research exploring this association was identified. Further work is required to better characterise the risks posed by stoma formation in this patient group.