Influence of Living Arrangements on Perioperative Cognitive Dysfunction Among Elderly Patients.

Abstract

Objective: The authors' aim in this study was to investigate the impact of various living arrangements on the occurrence of perioperative cognitive dysfunction (POCD) (now known as perioperative neurocognitive dysfunction, or PND) among elderly patients.

Methods: The authors' study cohort consisted of 162 elderly patients who underwent laparoscopic radical surgery for gastrointestinal cancer under general anesthesia. The authors categorized them into the following 5 groups based on their preoperative living arrangements: living with the spouse and children (group A); living with the spouse (group B); living with children (group C); living alone (group D); and living in a nursing home (group E). The authors observed and compared the preoperative and postoperative cognitive functions of the patients in the 5 groups.

Results: There was no statistically significant difference in age, sex, years of education, duration of surgery, duration of anesthesia, or postoperative visual Analog Scale (VAS) scores among the 5 groups of patients. However, the 5 groups of patients differed significantly with respect to preoperative mini-mental state examination (MMSE) scores, the difference between preoperative and postoperative scores, the preoperative rate of cognitive impairment, and the prevalence of postoperative POCD. When the authors examined the Montreal cognitive assessment (MoCA) scale scores, there were statistically significant differences in the preoperative scores, the difference between preoperative and postoperative scores, and the prevalence of postoperative POCD among the 5 groups. The prevalence of preoperative cognitive impairment, as diagnosed by the MMSE and MoCA scales, and the occurrence of POCD at 3 and 5 days post-surgery were similar. Logistic regression analysis of risk factors for POCD prevalence revealed that the living arrangement of elderly patients was a risk factor for the prevalence of POCD on day 3 post-surgery, whereas the living arrangement and the presence of preoperative cognitive impairment were risk factors for POCD on day 5 post-surgery.

Conclusion: The authors' study results highlighted the type of living arrangements of elderly patients as one of the factors that influence the prevalence of POCD in the immediate postoperative period. Elderly patients who preoperatively resided in a nursing home or those who lived alone were more likely to be associated with developing POCD.