Authors (including presenting author) :
Wong YHC, Lam WSV, Chu MHM
Affiliation :
Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
Evidence showed cognitive impairment, whether it is mild cognitive impairment to dementia, is associated with postoperative neurocognitive disorder. While WHO is estimating a doubling of elderly population from 12% to 22% from 2015 to 2050, we are expecting a growing number of elderly patients coming for various types of surgical procedures. This group of patient are at high risk of Perioperative neurocognitive disorder which could significantly affect surgical outcomes.
Objectives :
Early identification of high risk group is essential and the first step towards effective therapy and resources planning regarding public health. Patients above 60 year-old attending POMC received cognitive screening, with geriatric referral and follow-ups arranged for patients scored lower than 7.
Methodology :
All patients above 60 year-old attending POMC from July 2022 to June 2023 were included. They received cognitive screening by Abbreviated Mental Test (AMT-10) conducted by senior nurse in POMC. Geriatric referral would be made when the patient scored lower than 7. The AMT scores were also documented in the POMC nursing notes. Subsequent follow-ups were arranged by Geriatric team pre- or post-operatively according to the urgency of the operation.
Result & Outcome :
376 patients over 60 year-old were identified and screened during the pilot period, accounted for 62% of 603 patients attending POMC. 23 scored below 7 in the AMT (6.1%) Eight of them were referred to Geriatric unit for further assessment and management. Among the 15 whom were not referred to Geriatric assessment, 4 of them had known dementia, one had known psychiatric illness who had been referred to Geriatrician by the Psychiatrist; 2 patients had operation cancelled.
POMC serves only a small proportion of our patients scheduled for elective surgical interventions. We do see more elderly patients in Preoperative Assessment Service (PAS) and ward. However, cognitive screening in these setting would require quite a significant manpower input.The actual need for Perioperative brain protection is huge. This pilot demonstrated the potential huge demand in perioperative geriatric care in our hospital and the locality. The age threshold for screening could be increased for improving the cost-effectiveness of any screening program. The society and administrator should proactively consider putting more resources in elderly brain protection. In the long run, the use of AI or automated programs in screening can be introduced to allow quick and accurate assessment of cognitive function.
