The detection of psychiatric morbidity and its effects on outcome in acute elderly medical admissions (original) (raw)
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Prospective observational study of dementia in older patients admitted to acute hospitals
Australasian Journal on Ageing, 2013
Aim: Few Australian studies have examined the impact of dementia on hospital outcomes. The aim of this study was to determine the relative contribution of dementia to adverse outcomes in older hospital patients. Method: Prospective observational cohort study (n = 493) of patients aged Ն70 years admitted to four acute hospitals in Queensland. Trained research nurses completed comprehensive geriatric assessments using standardised instruments and collected data regarding adverse outcomes. The diagnosis of dementia was established by independent physician review of patients' medical records and assessments. Results: Patients with dementia (n = 102, 20.7%) were significantly older (P = 0.01), had poorer functional ability (P < 0.01), and were more likely to have delirium at admission (P < 0.01) than patients without dementia. Dementia (odds ratio = 4.8, P < 0.001) increased the risk of developing delirium during the hospital stay. Conclusion: Older patients with dementia are more impaired and vulnerable than patients without dementia and are at greater risk of adverse outcomes when hospitalised.
Age and ageing, 2015
previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. of 598 older patients admitted to acute ho...
Objectives: This study aims to determine the prevalence of potentially undetected dementia among institutional care facility residents in Ontario, Canada, and to identify factors associated with undetection. Methods: We utilized a population-based secondary data analysis approach, pertaining to data from the Canadian Institute for Health Information's Continuing Care Reporting System, 2009–2011. Potentially undetected dementia was defined as having severely impaired cognitive function and requiring extensive assistance on activity of daily living (ADL) but no records of dementia diagnoses. Cognitive function was measured by the Cognitive Performance Scale (CPS), 0 (intact) to 6 (very severe impairment), and ADL by a hierarchy scale, 0 (independent) to 6 (total dependence). Results: Of the 242,957 residents who had no records of dementia diagnoses, 11.6% (n = 28,078) had a CPS score ≥4 (severe impairment or higher) and ADL score ≥3 (required extensive assistance or more). Data from 11,614 demented residents with corresponding CPS and ADL scores were used for comparison. Residents without dementia diagnosis were younger (77 vs. 84 years), more likely to have never married (20% vs. 6%), and have longer admission (4 vs. 2.8 years). The most significant factors for no diagnoses were never married (adjusted odds ratio = 2.1, 95% confidence interval [CI] = 1.91–2.29), admitted to hospital-based facilities (adjusted odds ratio = 1.58, 95% CI = 1.48–1.69), presence of schizophrenia (adjusted odds ratio = 1.43, 95% CI = 1.22–1.69), depression (adjusted odds ratio = 1.23, 95% CI = 1.16–1.29), and diabetes mellitus (adjusted odds ratio = 1.32, 95% CI = 1.26–1.40). Conclusions: A large number of residents who had poor cognitive function and inadequate ADL ability did not have dementia diagnoses on record. Social and comorbid conditions were contributing factors to potentially undetected dementia.
The Prevalence of Dementia and Cognitive Impairment in Hospitals
Deutsches Arzteblatt International, 2018
I n 2016, 8.56 million older patients were treated on an inpatient basis in general hospital departments in Germany. This is equivalent to 44.7% of all inpatients of all age groups. The length of hospital stay of patients aged 65 or older was considerably longer compared with that of younger patients (8.1 days versus 4.9 days); as the result, older patients accounted for 57.1% of all days of inpatient treatment, making them the largest group of inpatients (1). A considerable number of older hospitalized patients with physical illnesses also suffer from dementia and related cognitive impairments. However, the exact number of patients experiencing these health problems is currently not known. Previous studies were almost impossible to compare because the methods they used varied widely and they typically comprised small, non-Working Group Psychiatric Epidemiology,
Dementia in the acute hospital: prospective cohort study of prevalence and mortality
British Journal of Psychiatry, 2009
BackgroundIncreasing numbers of people will die with dementia, many in the acute hospital. It is often not perceived to be a life-limiting illness.AimsTo investigate the prevalence of dementia in older people undergoing emergency medical admission and its effect on outcomes.MethodLongitudinal cohort study of 617 people (aged over 70). The main outcome was mortality risk during admission.ResultsOf the cohort, 42.4% had dementia (only half diagnosed prior to admission). In men aged 70–79, dementia prevalence was 16.4%, rising to 48.8% of those over 90. In women, 29.6% aged 70–79 had dementia, rising to 75.0% aged over 90. Urinary tract infection or pneumonia was the principal cause of admission in 41.3% of the people with dementia. These individuals had markedly higher mortality; 24.0% of those with severe cognitive impairment died during admission (adjusted mortality risk 4.02, 95% CI 2.24–7.36).ConclusionsThe rising prevalence of dementia will have an impact on acute hospitals. Extr...
Aging Clinical and Experimental Research, 2020
Objective Our aim was to measure the prevalence of delirium, its clinical features, and outcomes in older patients referred to a memory clinic. Methods A retrospective cohort study of 109 older outpatients with delirium referred to a memory clinic with a home care service. Delirium was diagnosed using the confusion assessment method and dementia with the DSM-5 criteria. We collected information on cognitive and functional status, mortality, institutionalization, and hospitalization during 6 months following the delirium episode. Results Delirium prevalence was 3.6%, mostly of hyperactive type. Delirium worsened functional (ADL 2.95 ± 1.95 vs. 2.16 ± 1.84) and cognitive (MMSE 13.88 ± 8.96 vs.11.0 ± 9.49) status after 6 months compared to the baseline. The mortality rate was 29.4%, and 28.3% were admitted to a long-term facility after the episode of delirium. Of these patients, more than half were hospitalized during the follow-up. Of the 109 patients with delirium, 85 were managed at home and 24 were hospitalized. Patients who were hospitalized had more severe behavioral symptoms during the delirium episode. There was no difference in mortality and institutionalization according to the home or hospital management. Conclusions This retrospective cohort study adds novel information to the existing literature of an understudied setting and population. The study supports the need to further investigate the feasibility and efficacy of the hospital at home models for the prevention and management of delirium in a high-risk population.
International Psychogeriatrics, 2011
The aim of this study was to describe the principal reasons for admission, medical comorbidities, interventions and outcomes of patients admitted to New South Wales hospitals with alcohol-related cognitive impairment. Methods: We extracted data from the NSW Admitted Patient Care Database for nearly 410 000 multi-day hospital admissions from 222 public hospitals ending between July 2006 and June 2007 for people aged 50 and over. Data linkage using a unique patient identifi er, derived by the Centre for Health Record Linkage identifi ed hospital transfers and readmissions for individual patients. Using ICD10-AM codes, we identifi ed patients with alcoholrelated dementia, amnesic syndrome due to alcohol, and Wernicke ' s encephalopathy, their principal reasons for admission and medical comorbidities, and procedures undertaken. Outcomes were length of stay, mortality, discharge destination, and readmission. Results: A total of 462 patients diagnosed with alcohol-related dementia (n ϭ 300; 82% male, mean age 63.9 years), Wernicke ' s encephalopathy (n ϭ 77) or amnesic syndrome due to alcohol (n ϭ 126) were identifi ed with overlap between diagnoses. Alcohol-related dementia occurred in 1.4% of dementia patients, and was more likely to occur in younger age groups and men than other types of dementia. Alcohol-related mental disorder was recorded in 70% of alcohol-related dementia multi-day admissions: dependence (52%), ' harmful use ' (11%) and withdrawal (12%). Principal reasons for admission for multi-day stays included alcohol-related mental disorder (18%), liver disease (11%) and injuries/poisonings (10%). Medical comorbidity was common. Like other dementia patients, alcoholrelated dementia patients had longer length of stay (mean of 15 days) than non-dementia patients and more transfers to residential care (7%). However, mortality was similar to nondementia patients (5%). Discharge at own risk was high (3.7%). Conclusions: Alcohol-related dementia is a preventable and potentially reversible condition. Investigation of intervention strategies initiated during hospitalization are warranted.
Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients
International Journal of Geriatric Psychiatry, 2009
Background Dementia is often considered a predictor of adverse hospitalization outcomes. However, the relative contributions of dementia and other risk factors remain unclear. Objective To assess, in a prospective study, the relative value of dementia for predicting hospitalization outcomes, taking into account comorbidity, functional and nutritional status in 435 inpatients (age 85.3 AE 6.7; 207 cognitively normal, 48 with mild cognitive impairment and 180 demented) from the acute and rehabilitation geriatric hospital of Geneva. Hospitalization outcomes (death in hospital, length of stay, institutionalisation and formal home care needs) were predicted using logistic regression models with sociodemographic characteristics, cognitive status, comorbid Charlson index-CCI, functional and nutritional status as independent variables. Results Moderate and severe dementia and poor physical function strongly predicted longer hospital stay, institutionalization and greater home care needs in univariate analyses. CCI was the best single predictor, with a four-fold difference in mortality rates between the highest and lowest scores. In multivariate analysis, the best predictor of institutionalisation was dementia, whereas the best predictor of death in hospital or longer hospital stay was higher comorbidity score, regardless of cognitive status. Functional status was the best predictor of greater home care needs. Conclusions Dementia in very old medically ill inpatients was predictive only of discharge to a nursing home. Higher levels of comorbidity and poor functional status were more predictive than dementia for the other three hospitalization outcomes. Thus, comorbid medical conditions, functional and nutritional status should be considered, together with cognitive assessment, when predicting hospitalization outcome.
The Prevalence and Management of Dementia and Other Psychiatric Disorders in Nursing Homes
International Psychogeriatrics, 1990
The prevalence of psychiatric disorders among new admissions to nursing homes is unknown. Such data are needed to estimate the psychiatric needs of this population. We report the prevalence of specific psychiatric disorders in 454 consecutive new nursing home admissions who were evaluated by psychiatrists and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised. Eighty percent had a psychiatric disorder. The commonest were dementia syndromes (67.4%) and affective disorders (10%). Also, 40% of demented patients had additional psychiatric syndromes such as delusions or depression, and these patients constituted a distinct subgroup that predicted frequent use of restraints and neuroleptics, and the greatest consumption of nursing time. These data demonstrate that the majority of nursing home residents have psychiatric disorders on admission, and that their management is often quite restrictive. Research is now needed to determine the ...