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A Prospective Observational Cohort Study of Language Preference and Preoperative Cognitive Screening in Older Adults

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AUTHORS: Canales, Cecilia MD, MPH et al 

Anesthesia & Analgesia 139(5):p 903-911, November 2024. |

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 English-speaking counterparts when routine screening was instituted. We also aimed to measure the association between preoperative Mini-Cog and postoperative delirium (POD) in both English-speaking and LOE patients.

METHODS:

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 compared 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).

CONCLUSIONS:

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.

KEY FINDINGS

  • Question: Does preoperative cognitive screening occur at the same rate in those with language preference other than English when compared with English preference?
  • Findings: Differences exist in the rates of cognitive screening between English-speaking and language other than English-speaking patients.
  • Meaning: By ignoring older adults who speak a language other than English during preoperative cognitive screening, health disparities may be introduced, which has implications for postoperative complications.
  • Question: Is preoperative Mini-Cog associated with postoperative delirium in older adults who speak a language other than English?
  • Findings: Abnormal Mini-Cog scores are associated with postoperative delirium in those who speak English and in those whose a language preference is other than English.
  • Meaning: Preoperative Mini-Cog screening has the potential to identify those at risk of developing postoperative delirium, regardless of primary language.

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