Impact and recognition of cognitive impairment among hospitalized elders

Abstract

BACKGROUND:Older adults are predisposed to developing cognitive deficits. This increases their vulnerability for adverse health outcomes when hospitalized.OBJECTIVE:To determine the prevalence and impact of cognitive impairment (CI) among hospitalized elders based on recognition by lCD‐coding versus screening done on admission.DESIGN:Observational cohort study.SETTING:Urban public hospital in Indianapolis.PATIENTS:997 patients age 65 and older admitted to medical services between July 2006 and March 2008.MEASUREMENTS:Impact of CI in terms of length of stay, survival, quality of care and prescribing practices. Cognition was assessed by the Short Portable Mental Status Questionnaire (SPMSQ).RESULTS:424 patients (43%) were cognitively impaired. Of those 424 patients with CI, 61% had not been recognized by ICD‐9 coding. Those unrecognized were younger (mean age 76.1 vs. 79.1, P <0.001); had more comorbidity (mean Charlson index of 2.3 vs.1.9, P = 0.03), had less cognitive deficit (mean SPMSQ 6.3 vs. 3.4, P < 0.001). Among elders with CI, 163 (38%) had at least one day of delirium during their hospital course. Patients with delirium stayed longer in the hospital (9.2 days vs. 5.9, P < 0.001); were more likely to be discharged into institutional settings (75% vs. 31%, P < 0.001) and more likely to receive tethers during their care (89% vs. 69%, P < 0.001), and had higher mortality (9% vs. 4%, P = 0.09).CONCLUSION:Cognitive impairment, while common in hospitalized elders, is under‐recognized, impacts care, and increases risk for adverse health outcomes. Journal of Hospital Medicine 2010;5:69–75. © 2010 Society of Hospital Medicine.

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

“…3,4,6,[9][10][11] Furthermore, increased complexity of the discharge instructions due to a greater burden of comorbid illnesses and higher prevalence of cognitive impairment among older adults may result in an elevated risk of non-comprehension. 1,2,[12][13][14] In this study, we determined the prevalence of noncomprehension of the discharge instructions and identified patient characteristics associated with non-comprehension among older adults discharged from the medical and surgical units of a large urban hospital. As a secondary analysis, we assessed the prevalence of non-compliance with the discharge instructions and analyzed factors associated with noncompliance among study participants who understood their discharge instructions.…”

Ten ways to improve the care of elderly patients in the hospital

“…Two geriatric syndromes in particular, delirium and falls, are associated with increased length of stay, increased healthcare costs, and substantial morbidity. 9,10 Multifactorial interventions such as the Hospital Elder Life Project (HELP) have been shown to prevent delirium and falls. [11][12][13][14] Studies of the HELP intervention demonstrated benefits on outcomes that are important to hospitalists, including shortened length of stay.…”

A Pilot Program to Improve Recognition of Cogntive Impairment in Acute Care

“…5 Patients may not receive the ideal level of care even if the presence of CI is established, and very disturbingly, as many as 60% 5 of patients with CI will not have the diagnosis noted on their chart.…”