• Am. J. Crit. Care · Nov 2020

    Executive Function, Dexterity, and Discharge Disposition in Older Intensive Care Unit Survivors.

    • Maya N Elías, Cindy L Munro, and Zhan Liang.
    • Maya N. Elías is a postdoctoral research fellow, Cindy L. Munro is dean and a professor, and Zhan Liang is an assistant professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida.
    • Am. J. Crit. Care. 2020 Nov 1; 29 (6): 484488484-488.

    BackgroundDexterity is a component of motor function. Executive function, a subdomain of cognition, may affect dexterity in older adults recovering from critical illness after discharge from an intensive care unit (ICU).ObjectivesTo explore associations between executive function (attention and cognitive flexibility) and dexterity (fine motor coordination) in the early post-ICU period and examine dexterity by acuity of discharge disposition.MethodsThe study involved 30 older adults who were functionally independent before hospitalization, underwent mechanical ventilation in the ICU, and had been discharged from the ICU 24 to 48 hours previously. Dexterity was evaluated with the National Institutes of Health Toolbox (NIHTB) Motor Battery 9-Hole Pegboard Dexterity Test (PDT); attention, with the NIHTB Cognition Battery Flanker Inhibitory Control and Attention Test (FICAT); and cognitive flexibility, with the NIHTB Cognition Battery Dimensional Change Card Sort Test (DCCST). Exploratory regression was used to examine associations between executive function and dexterity (fully corrected T scores). Independent-samples t tests were used to compare dexterity between participants discharged home and those discharged to a facility.ResultsFICAT (β = 0.375, P = .03) and DCCST (β = 0.698, P = .001) scores were independently and positively associated with PDT scores. Further, PDT scores were worse among participants discharged to a facility than among those discharged home (mean [SD], 26.71 [6.14] vs 36.33 [10.30]; t24 = 3.003; P = .006).ConclusionsPoor executive function is associated with worse dexterity; thus, dexterity may be a correlate of both post-ICU cognitive impairment and functional decline. Performance on dexterity tests could identify frail older ICU survivors at risk for worse discharge outcomes.©2020 American Association of Critical-Care Nurses.

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