住院年老病患的認知功能

Cognitive Function of Elderly Patients

認知功能障礙是住院老人常見的健康問題，但認知功能檢查未列入常規檢查，且國內相關研究不多。本研究之目的是探討住院老年病人認知功能的狀況及影響其認知功能的相關因素。本研究是描述性、相關性研究，在台北市一家醫學中心之骨科和泌尿科病房共收集801位個案，個案均符合下列條件：(1)年齡在65歲或以上；(2)沒有膽妄、失語、完全失明、完全失聰的問題；(3)能以國、台、或客語溝通。個案在入院48小時內受訪，以巴氏指數測其日常生活功能，以迷你心智狀態按查量表(MMSE)測其認知口功能，以身體功能量表測其視、聽、及說話能力，並記錄其生化檢驗值。結果顯示若以MMSE分數23/24為切點，則有19.5%認知功能損傷。個案得分正確率最高的題目是訊息登錄，正確率最低的是描繪圖案。Logistic多變項回歸分析顯示年紀大、教育程度低、日常活動功能差、血糖高與認知功能損傷有闕，其相對危險性分別是1.89、3.74、2.19、1.45。

Cognitive impairment is a common problem in hospitalized older patients. However, cognitive function is generally not assessed as part of the admission routime and little research has been done on the cognitive function of older hospitalized patients. The objectives of this cross-sectional study were to examine the cognitive function of older hospitalized patients in orthopedic and urological wards and to identify factors predictive of their cognitive function. Data were collected from older patients in the orthopedic and urologic wards of an urban tertiary care center, within 48 hours of admission. Patient's demographic and laboratory data were recorded. The Barthel index was used to measure patients' function in performing activities of daily living (ADL). Patients' visual, auditory, and speech functions were evaluated by means of the physical function scale. Cognitive status was measured with the Mini-Mental State Examination (MMSE). Eight hundred and one consecutive older patients were enrolled. All subjects met the following criteria: (1) 65 years of age or older, (2) not unconsciousness, delirious, deaf, or aphasic upon admission, (3) able to communicate verbally. The overall incidence of cognitive impairment among these subjects was 19.5% if we used a CMMSE score of 23/24 as the cutoff point. Subjects performed best on the dimension of information registration. ＂Copy figure＂ was the dimension that most subjects failed to do. Multivariate logistic regression analysis identified older age (odds ratio (OR) = 1.87), lower education (OR = 3.74), poor ADL function (OR= 2.19), and abnormal fasting blood glucose level (OR = 1.45) as being associated with cognitive impairment.