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老年语言偏好和术前认知筛查的前瞻性观察队列研究：筛查是否存在语言差异以及测试结果与术后谵妄间的关联是否因语言偏好而异？
贵州医科大学 麻醉与心脏电生理课题组
翻译：周菁 编辑：田明德 审校：曹莹
背景：每年对65岁或65岁以上的患者进行的外科手术比例更高。同时，在英语国家（如美国、英国、澳大利亚和加拿大），越来越多的患者偏好英语以外的语言（LOE）。我们的目的是衡量在进行常规筛查时，LOE患者接受认知筛查的比例是否与英语患者相同。我们旨在测量在讲英语和LOE患者中术前Mini-Cog和术后谵妄（POD）之间的相关性。
方法：我们对65岁或65岁以上的患者进行了单中心观察性队列研究，这些患者计划进行手术，并在术前门诊进行评估。建议将老年人认知筛查作为所有65岁及65岁以上患者术前门诊的机构项目。我们测量了认知筛查的项目依从性。我们还评估了英语和LOE患者术前Mini-Cog和POD的相关性，以及两组之间的相关性是否不同。Mini-Cog评分≤2被认为是受损。术后，使用混淆评估方法（CAM）和系统图表回顾评估患者的POD。
结果：在3年期间（2019年2月至2022年1月），2446名65岁或以上的患者在术前门诊接受了评估。在这1956名患者中，接受了认知筛查。89%的英语患者接受了术前认知筛查，而LOE患者的这一比例为58%。与LOE患者相比，英语患者进行Mini-Cog评估的几率高5.6倍（95%可信区间[CI]，4.6-7.0）P<.001。在Mini-Cog筛查呈阳性的英语患者中，与Mini-Cog阴性相比，停药后精神错乱的几率高3.5倍（95%CI，2.6-4.8）P<.001。在LOE患者中，Mini-Cog阳性与Mini-Cog阴性相比，停药后精神错乱的几率高3.9倍（95%CI，2.1-7.3）P<.001。两组比值比差异不显著（P=0.753）。
结论：我们观察到LOE患者在术前进行认知筛查的比率存在差异，尽管在英语和LOE患者中Mini-Cog与POD相关。应努力找出英语熟练的老年人认知筛查的障碍。
原始文献来源：Canales,C. , Ramirez,C.M. , Yang,S.C. , Feinberg,S.A. , Grogan,T.R. , Whittington,R.A. , Sarkisian,C. ,& Cannesson , M.(2024).A Prospective Observational Cohort Study of Language Preference and Preoperative Cognitive Screening in Older Adults: Do Language Disparities Exist in Cognitive Screening and Does the Association Between Test Results and Postoperative Delirium Differ Based on Language Preference?.Anesthesia & Analgesia,139(5),903-911.
A Prospective Observational Cohort Study of Language Preference and Preoperative Cognitive Screening in Older Adults: Do Language Disparities Exist in Cognitive Screening and Does the Association Between Test Results and Postoperative Delirium Differ Based on Language Preference?
Abstract
Background:A greater percentage of surgical procedures are being performed each year on patients 65 years of age or older. Concurrently, a growing proportion of patients in English-speaking countries such as the United States, United Kingdom, Australia, and Canada have a language other than English (LOE) preference. We aimed to measure whether patients with LOE underwent cognitive screening at the same rates as their nglish-speaking counterparts when routine screening was instituted. We also aimed to measure the association between preopera-tive Mini-Cog and postoperative delirium (POD) in both English-speaking and LOE patients.
Method:We conducted a single-center, observational cohort study in patients 65 years old or older, scheduled for surgery and evaluated in the preoperative clinic. Cognitive screening of older adults was recommended as an institutional program for all patients 65 and older presenting to the preoperative clinic. We measured program adherence for cognitive screening. We also assessed the association of preoperative impairment on Mini-Cog and POD in both English-speaking and LOE patients, and whether the association differed for the 2 groups. A Mini-Cog score ≤2 was considered impaired. Postoperatively, patients were assessed for POD using the Confusion Assessment Method (CAM) and by systematic chart review.
Results:Over a 3-year period (February 2019–January 2022), 2446 patients 65 years old or older were assessed in the preoperative clinic prior. Of those 1956 patients underwent cognitive screening. Eighty-nine percent of English-speaking patients underwent preoperative cognitive screening, compared to 58% of LOE patients. The odds of having a Mini-Cog assessment were 5.6 times higher (95% confidence interval [CI], 4.6–7.0) P < .001 for English-speaking patients compared to LOE patients. In English-speaking patients with a positive Mini-Cog screen, the odds of having postop delirium were 3.5 times higher (95% CI, 2.6–4.8) P < .001 when com-pared to negative Mini-Cog. In LOE patients, the odds of having postop delirium were 3.9 times higher (95% CI, 2.1–7.3) P < .001 for those with a positive Mini-Cog compared to a negative Mini-Cog. The difference between these 2 odds ratios was not significant (P = .753).
Conclusion:We observed a disparity in the rates LOE patients were cognitively screened before surgery, despite the Mini-Cog being associated with POD in both English-speaking and LOE patients. Efforts should be made to identify barriers to cognitive screening in limited English-proficient older adults.
