ORIGINAL RESEARCH
Jeanette M. Daly, RN, PhD; Yinghui Xu, MS; Seth D. Crockett, MD, MPH; Richard M. Hoffman, MD, MPH; Barcey T. Levy, PhD, MD
Corresponding Author: Jeanette M. Daly, RN, PhD; Department of Family Medicine, Carver College of Medicine
Email: jeanette-daly@uiowa.edu
DOI: 10.3122/jabfm.2024.240338R1
Keywords: Cancer Screening, Cathartics, Clock Test, Cognition, Cognitive Impairments, Cohort Studies, Colonoscopy, Cross-Sectional Studies, Quantitative Research, Screening
Dates: Submitted: 09-13-2024; Revised: 12-12-2024; Accepted: 01-06-2025
Status: In production for ahead of print.
PURPOSE: Inadequate bowel preparation (IBP) for colonoscopies is associated with missed polyps and cancers, prolonged procedure times, lower colonoscopy completion rates, and need for a repeat procedure. The purposes of this study were to assess: 1) whether impaired cognitive status (measured by an abnormal clock drawing test) was associated with IBP, and 2) the association of participant demographic and clinical characteristics with IBP.
METHODS: Cross-sectional cohort study conducted in three academic centers. Subjects, 50 to 85 years old, completed five stool tests on a single sample and a clock drawing before undergoing a screening or surveillance colonoscopy. Clock drawings were validated by the Mendes-Santos method and Watson method. A generalized linear mixed model was conducted to estimate factors associated with IBP, based on Aronchick bowel preparation score.
RESULTS: The 2016 participants had a mean age of 63 years (SD = 7.95); 1274 (63%) were female; 119 (6%) had IBP; and 421 (21%) had an abnormal clock drawing. After controlling for age in the multivariable model, the odds of having an IBP vs. adequate were 1.44 (95% CI, 0.94- 2.22) for those with an abnormal clock drawing score compared to those with a normal score. The only variable significantly associated with IBP was household income, with an odds of 2.48 (95% CI, 1.56-3.95) for household income of <$40,000 compared to income >$80,000.
CONCLUSIONS: Lower household income was associated with greater odds of IBP. The association between an abnormal clock drawing score and IBP was not statistically significant.