Prevalence of Cognitive Impairment in the Hospitalized Elderly

Hickey, Ann; Clinch, David; Groarke, E. P.

doi:10.1002/(sici)1099-1166(199701)12:1<27::aid-gps446>3.0.co;2-f

Cited by 46 publications

(15 citation statements)

References 11 publications

(11 reference statements)

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“…Also, because using MMSE comes with practical limitations, some patients with severe illness or severe confusion are typically excluded, which may result in sampling bias. Finally, prevalence of cognitive impairment in our study was larger (62%) than expected for this type of population, 5,40,41 probably because patients were recruited on geriatric wards, instead of general medical wards. We cannot exclude the possibility that this high prevalence may have affected the results.…”

Section: Discussionmentioning

confidence: 99%

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Wellens

Flamaing

Tournoy

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective: The Cognitive Performance Scale (CPS) is generated from five items of the interRAI/ Minimum Data Set instruments, a comprehensive geriatric assessment method. CPS was initially designed to assess cognition in residential care, where it has shown good psychometric performance. We evaluated the performance of the interRAI Acute Care in identifying cognitive impairment among patients hospitalized on acute geriatric wards. Methods: An observational study was conducted on two geriatric wards. Trained raters independently completed the interRAI Acute Care and the Mini-Mental State Examination (MMSE) in 97 inpatients (85 AE 5 years; 67% female). The level of agreement between CPS and MMSE was explored using comparisons of means, agreement coefficients, and diagnostic accuracy. Results: Cognitive impairment was present in 61% of the participants. Average MMSE scores were significantly different between groups with low CPS scores compared with those with high CPS scores (p <0.05). CPS explained only 48.8% of the variability in MMSE. Agreement in defining cognitively impaired subjects was moderate (percentage observed agreement, 68%; k ¼ 0.41). With MMSE score less than 24 as a gold standard, diagnostic accuracy of CPS was moderate (area under curve ¼ 0.73), with low sensitivity, but excellent specificity. When lowering the MMSE cutoff to less than 18 and focusing on patients with severe cognitive impairment, CPS agreement coefficients and sensitivity increased but specificity decreased. Using education-adjusted MMSE cutoffs did not substantially affect the results. Conclusion: CPS can be used for coarse triage between intact and severe cognitive impairment. Although promising results have been obtained in residential and community settings, our results suggest that CPS fails to differentiate across different levels of cognitive impairment in hospitalized geriatric patients. (Am J Geriatr Psychiatry 2013; 21:636e645)

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Section: Discussionmentioning

confidence: 99%

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Wellens

Flamaing

Tournoy

et al. 2013

The American Journal of Geriatric Psychiatry

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“…Complicated transitions (i.e., a visit to the emergency department or a re-admission to the hospital within 30 days of discharge) occur frequently in this population 7 . Furthermore, these patients are often unable to advocate for themselves (as co-morbid dementia is common) 19,20 , and are heavily reliant on good discharge summary communication for a smooth transition to a subacute care facility 6,7 . If key information regarding pending lab tests is left out of the discharge summary, important follow-up of critical lab results may not occur, possibly leading to medical errors and patient harm, with increased risk of re-admission.…”

Section: Discussionmentioning

confidence: 99%

Pending Laboratory Tests and the Hospital Discharge Summary in Patients Discharged To Sub-Acute Care

et al. 2010

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BACKGROUND:Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk population, specifically those patients discharged to sub-acute care (i.e., skilled nursing, rehabilitation, long-term care), remains unknown. OBJECTIVE: To determine the prevalence and nature of lab tests pending at hospital discharge and their inclusion within hospital discharge summaries, for common sub-acute care populations. DESIGN: Retrospective cohort study. PARTICIPANTS: Stroke, hip fracture, and cancer patients discharged from a single large academic medical center to sub-acute care, 2003-2005 (N=564) MAIN MEASURES: Pending lab tests were abstracted from the laboratory information system (LIS) and from each patient's discharge summary, then grouped into 14 categories and compared. Microbiology tests were subdivided by culture type and number of days pending prior to discharge. KEY RESULTS: Of sub-acute care patients, 32% (181/ 564) were discharged with pending lab tests per the LIS; however, only 11% (20/181) of discharge summaries documented these. Patients most often left the hospital with pending microbiology tests (83% [150/181]), particularly blood and urine cultures, and reference lab tests (17% [30/181]). However, 82% (61/74) of patients' pending urine cultures did not have 24-hour preliminary results, and 19% (13/70) of patients' pending blood cultures did not have 48-hour preliminary results available at the time of hospital discharge. CONCLUSIONS: Approximately one-third of the subacute care patients in this study had labs pending at discharge, but few were documented within hospital discharge summaries. Even after considering the availability of preliminary microbiology results, these omissions remain common. Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved communication has on patient outcomes.KEY WORDS: laboratory tests; hospital discharge; sub-acute care.

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“…Dementia is prevalent in 42% of older people admitted to general hospital [3] though published prevalence figures range from 5-45% [3][4][5][6][7][8][9][10][11]. Patients with dementia often have difficulty communicating their needs, and in a hospital setting have a high prevalence of delirium (66%) [12], and psychological symptoms in the absence of delirium (depression (34%), anxiety (35%), delusions (11%) and hallucinations (15%)) [13].…”

Section: Introductionmentioning

confidence: 99%

“…Previous attempts to describe dementia prevalence, and the symptoms associated with it, in a general hospital setting have involved prospective objective memory screening, and subsequent clinical assessment [3][4][5][6][7][8][9][10][11][12][13]17]. The rigorous screening methods these studies employ may give an accurate account of the hospital prevalence but they potentially overestimate the actual clinical record, that is, the number of patients with a pre-existing diagnosis of dementia identified as such during their hospital stay and the number of symptoms recorded.…”

Section: Introductionmentioning

confidence: 99%

How well are the diagnosis and symptoms of dementia recorded in older patients admitted to hospital?

2016

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Prevalence of Cognitive Impairment in the Hospitalized Elderly

Cited by 46 publications

References 11 publications

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Pending Laboratory Tests and the Hospital Discharge Summary in Patients Discharged To Sub-Acute Care

How well are the diagnosis and symptoms of dementia recorded in older patients admitted to hospital?

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