Journal of the American Medical Directors Association · 2025
Does Cognitive Function Influence the Benefits of Multicomponent Team Interventions?
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Lange Allison V, Glickman Amanda, Wells Kevin, Mee Thomas C, Carey Evan P, Kavalieratos Dio, Bettcher Brianne M, Kluger Benzi, Bekelman David B
Аннотация
OBJECTIVES: This study examined whether cognitive function influenced the benefits of multicomponent team interventions designed to improve quality of life.
DESIGN: Data from 2 multisite randomized trials of multicomponent interventions were pooled. The interventions involved symptom management by a nurse, psychosocial counseling by a social worker, and collaboration among palliative care, primary care, and specialists.
SETTING AND PARTICIPANTS: Patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and heart failure (HF) enrolled in 2 multisite randomized trials.
METHODS: Cognitive function was assessed using the Telephone Interview for Cognitive Status (TICS) and analyzed continuously and dichotomously (<36 on TICS indicating cognitive dysfunction). Mixed-effects linear regression models assessed whether cognitive function modified the effect of the interventions on quality of life and related outcomes. We also explored whether cognitive function was associated with the number of intervention visits, intervention staff time, and completed study team recommendations (consults, tests, behavior changes).
RESULTS: A total of 610 participants across both trials had a mean age of 67 years, nearly all had HF or COPD, and a small proportion had ILD; 83% of participants screened positive for cognitive dysfunction. Cognitive function did not influence the benefits of the interventions across outcomes (P > .10). In exploratory analyses, lower TICS scores were associated with fewer completed intervention visits (P = .007). Total staff time, consults, tests, and behavior change recommendations were similar across TICS scores.
CONCLUSIONS AND IMPLICATIONS: Cognitive dysfunction is prevalent among patients with chronic cardiopulmonary illnesses. Intervention benefits were not affected by cognitive status. Exploratory analyses found an association between worse cognitive function and fewer intervention visits but no difference in intervention time, tests, or behavior change recommendations. Increased effort to identify cognitive dysfunction in this population and engage them in interventions to improve quality of life should be considered.
DESIGN: Data from 2 multisite randomized trials of multicomponent interventions were pooled. The interventions involved symptom management by a nurse, psychosocial counseling by a social worker, and collaboration among palliative care, primary care, and specialists.
SETTING AND PARTICIPANTS: Patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and heart failure (HF) enrolled in 2 multisite randomized trials.
METHODS: Cognitive function was assessed using the Telephone Interview for Cognitive Status (TICS) and analyzed continuously and dichotomously (<36 on TICS indicating cognitive dysfunction). Mixed-effects linear regression models assessed whether cognitive function modified the effect of the interventions on quality of life and related outcomes. We also explored whether cognitive function was associated with the number of intervention visits, intervention staff time, and completed study team recommendations (consults, tests, behavior changes).
RESULTS: A total of 610 participants across both trials had a mean age of 67 years, nearly all had HF or COPD, and a small proportion had ILD; 83% of participants screened positive for cognitive dysfunction. Cognitive function did not influence the benefits of the interventions across outcomes (P > .10). In exploratory analyses, lower TICS scores were associated with fewer completed intervention visits (P = .007). Total staff time, consults, tests, and behavior change recommendations were similar across TICS scores.
CONCLUSIONS AND IMPLICATIONS: Cognitive dysfunction is prevalent among patients with chronic cardiopulmonary illnesses. Intervention benefits were not affected by cognitive status. Exploratory analyses found an association between worse cognitive function and fewer intervention visits but no difference in intervention time, tests, or behavior change recommendations. Increased effort to identify cognitive dysfunction in this population and engage them in interventions to improve quality of life should be considered.