Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition

Timmons, Suzanne; Manning, Edmund; Barrett, Aoife; Brady, Noeleen M.; Browne, Vanessa; O'Shea, Emma; Molloy, D. William; O’Regan, N; Trawley, Steven; Cahill, Suzanne; O'Sullivan, Katie; Woods, Noel; Meagher, David; Chorcorain, Aoife M. Ni; Linehan, John

doi:10.1093/ageing/afv131

Cited by 138 publications

(130 citation statements)

References 26 publications

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“…The prevailing principal diagnosis within the cohort with dementia was pneumonia (18.2%), followed by cardiac conditions (15.5%), gastrointestinal issues (7.4%), and urinary tract infections (5.4%). Timmons et al provides a full breakdown of the demographic and clinical statistics of patients with and without dementia.…”

Section: Resultsmentioning

confidence: 99%

“…We used primary data from a nonconsecutive, prospective cohort study of patients aged ≥70 years, including elective (non day case) and unplanned admissions to any speciality across six acute hospitals in Cork County between May 2012 and February 2013 (14 collection days per hospital: preplanned and staggered over 6 weeks; all days of week evenly represented; all patients admitted in the 24‐hour period included) . In this study, patients consenting to inclusion and not critically ill had been assessed within 48 hours of admission (90% of all admissions included, n = 606).…”

Section: Methodsmentioning

confidence: 99%

“…A recent Irish multihospital observational study identified a dementia prevalence of 25% amongst older hospitalised patients of whom just over 35% had a previously known diagnosis (listed in GP letter, medical notes, or report of a family member). Of those with a known diagnosis of dementia, only 20% of cases had been captured by the hospital inpatient enquiry (HIPE) registry …”

Section: Introductionmentioning

confidence: 99%

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Dementia in older people admitted to hospital: An analysis of length of stay and associated costs

Ahern

Cronin

Woods

et al. 2018

Int J Geriat Psychiatry

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Objectives Patients with dementia in the acute setting are generally considered to impose higher costs on the health system compared to those without the disease largely due to longer length of stay (LOS). Many studies exploring the economic impact of the disease extrapolate estimates based on the costs of patients diagnosed using routinely collected hospital discharge data only. However, much dementia is undiagnosed, and therefore in limiting the analysis to this cohort, we believe that LOS and the associated costs of dementia may be overestimated. We examined LOS and associated costs in a cohort of patients specifically screened for dementia in the hospital setting. Methods Using primary data collected from a prospective observational study of patients aged ≥70 years, we conducted a comparative analysis of LOS and associated hospital costs for patients with and without a diagnosis of dementia. Results There was no significant difference in overall length of stay and total costs between those with (μ = 9.9 days, μ = € 8246) and without (μ = 8.25 days, μ = € 6855) dementia. Categorical data analysis of LOS and costs between the two groups provided mixed results. Conclusions The results challenge the basis for estimating the costs of dementia in the acute setting using LOS data from only those patients with a formal dementia diagnosis identified by routinely collected hospital discharge data. Accurate disease prevalence data, encompassing all stages of disease severity, are required to enable an estimation of the true costs of dementia in the acute setting based on LOS.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dementia in older people admitted to hospital: An analysis of length of stay and associated costs

Ahern

Cronin

Woods

et al. 2018

Int J Geriat Psychiatry

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“…The prevalence of dementia amongst patients of 70 years and older in hospital ranges between a third (Briggs et al, 2016), 25%-29% (Timmons et al, 2015) and 42.4% (Sampson, Blanchard, Jones, Tookman, & King, 2009). The prevalence of dementia amongst patients of 70 years and older in hospital ranges between a third (Briggs et al, 2016), 25%-29% (Timmons et al, 2015) and 42.4% (Sampson, Blanchard, Jones, Tookman, & King, 2009).…”

Section: Limitationsmentioning

confidence: 99%

Understanding assessment on a hospital ward for older people: A qualitative study

Wiltjer

Seers

Tutton

2019

Journal of Advanced Nursing

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Aim To explore assessment on a hospital ward for older people from the perspectives of patients and healthcare professionals. Design A qualitative study drawing on grounded theory was undertaken between February 2015 ‐ January 2016. Methods Interviews with 15 patients and 22 healthcare professionals, a focus group with six healthcare professionals, 45 hr of observation and review of 18 sets of patient notes. Analysis was conducted using initial and focused coding, continuously comparing data, emerging codes and themes. Findings The core category was navigating, constructed through three themes: containing complexity, networking, and situating the process. Navigating assessment was a complex, flexible, context dependent, and social process where healthcare professionals used a combination of formal, informal, visible, and invisible ways of working. Registered nurses were at the centre of networking and focused on gathering and sharing information in the multi‐disciplinary team, whilst patients had a passive role despite a variety of preferences about their involvement. Conclusions Navigating the assessment of older people is contextually situated, includes networking and a professional focus on containing complexity. This process may be enhanced by: (a) making informal assessment visible to others; (b) developing the nurses’ role beyond chasing information towards coordinating care; and (c) asking patients and acting on how they would like to be involved in decision‐making. Impact Acknowledging that navigating assessment is a social, flexible and complex process, including different ways of working to meet patient needs, may enhance the usability of current assessment guidelines and their development.

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“…Individuals with dementia often present to acute care without a prior diagnosis [1]. There is, therefore, a need to screen for cognitive impairment among older adult patients attending hospital.…”

Section: Introductionmentioning

confidence: 99%

Validity and Reliability of the 6-Item Cognitive Impairment Test for Screening Cognitive Impairment: A Review

O'Sullivan

O’Regan

Timmons³

2016

Dement Geriatr Cogn Disord

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Background: A large proportion of older adults with dementia remain undiagnosed, presenting to hospital with occult dementia, and are at risk for adverse outcomes, especially delirium. Routine screening for cognitive impairment among older adult patients presenting to acute hospitals could help alleviate this problem; however, this is hampered by time constraints, poor knowledge of screening instruments and lack of consensus as to which screening tool is best. Cognitive tests with attention items may be particularly useful in acute settings, given the importance of delirium detection. However, it is crucial that cognitive screening instruments are fast and reliable. Summary: The Six-Item Cognitive Impairment Test (6-CIT) is a feasible instrument for cognitive screening among older adults attending a general practitioner or hospital. Although researchers have investigated its accuracy in diagnosing cognitive impairment in primary and secondary care settings, its validity in primary care use has been questioned and there are limited validation studies on its use in secondary care. Key Messages: This paper presents a review of validation studies conducted on the 6-CIT. We recommend that larger studies, which test the psychometric properties of the 6-CIT in primary and acute care settings, are conducted to establish recommendations for routine screening use.

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Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition

Cited by 138 publications

References 26 publications

Dementia in older people admitted to hospital: An analysis of length of stay and associated costs

Dementia in older people admitted to hospital: An analysis of length of stay and associated costs

Understanding assessment on a hospital ward for older people: A qualitative study

Validity and Reliability of the 6-Item Cognitive Impairment Test for Screening Cognitive Impairment: A Review

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