Is Cognitive Function a Concern in Independent Elderly Adults Discharged Home from the Emergency Department in Canada After a Minor Injury?

• Published in: Journal of the American Geriatrics Society (JAGS) 2014-11, Vol.62 (11), p.2130-2135
• Main Authors: Ouellet, Marie-Christine, Sirois, Marie-Josée, Beaulieu-Bonneau, Simon, Morin, Jacques, Perry, Jeffrey, Daoust, Raoul, Wilding, Laura, Provencher, Véronique, Camden, Stéphanie, Allain-Boulé, Nadine, Émond, Marcel
• Format: Article
• Language: English
• Subjects: Accidental Falls - statistics & numerical data; Biological and medical sciences; Cognition & reasoning; Cognition Disorders - diagnosis; Cognition Disorders - epidemiology; Cognition Disorders - psychology; cognitive status; Cohort Studies; Cross-Sectional Studies; Documentation - statistics & numerical data; Emergency medical care; emergency medicine; Emergency Service, Hospital - utilization; Falls; Follow-Up Studies; General aspects; Geriatrics; Humans; Independent Living; Injuries; Medical sciences; minor injury; Miscellaneous; Montreal Cognitive Assessment; Neuropsychological Tests - statistics & numerical data; Patient Discharge; Patient Readmission - statistics & numerical data; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quebec; Reference Values; Risk Factors; Self Care; Statistics as Topic; Utilization Review - statistics & numerical data; Wounds and Injuries - therapy
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.13081

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.