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The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study

The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study
The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study
Background
older people with dementia admitted to hospital for acute illness have higher mortality and longer hospital stays compared to those without dementia. Cognitive impairment (CI) is common in older people, and they may also be at increased risk of poor outcomes.

Methods
retrospective observational study of unscheduled admissions aged ≥75 years. Admission characteristics, mortality rates and discharge outcomes were compared between three groups: (i) known dementia diagnosis (DD), (ii) CI but no diagnosis of dementia and (iii) no CI.

Results
of 19,269 admissions (13,652 patients), 19.8% had a DD, 11.6% had CI and 68.6% had neither. Admissions with CI or DD were older and had more females than those with no CI, and were more likely to be admitted through the Emergency Department (88.4% and 90.7%, versus 82.0%) and to medical wards (89.4% and 84.4%, versus 76.8%). Acuity levels at admission were similar between the groups. Patients with CI or DD had more admissions at ‘high risk’ from malnutrition than patients with no CI (28.0% and 33.7% versus 17.5%), and a higher risk of dying in hospital (11.8% [10.5–13.3] and 10.8% [9.8–11.9] versus (6.6% [6.2–7.0])).

Conclusions
the admission characteristics, mortality and length of stay of patients with CI resemble those of patients with diagnosed dementia. Whilst attention has been focussed on the need for additional support for people with dementia, patients with CI, which may include those with undiagnosed dementia or delirium, appear to have equally bad outcomes from hospitalisation.
0002-0729
Fogg, Carole
4de62ea5-f8b0-423b-a880-58d71a18d428
Meredith, Paul
d0a0e287-ad7f-41cb-9347-94d7a0e957c1
Bridges, Jacqueline
57e80ebe-ee5f-4219-9bbc-43215e8363cd
Gould, Gill P.
00cbb1c3-b06d-4b6a-ad32-a48c143d36ae
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Fogg, Carole
4de62ea5-f8b0-423b-a880-58d71a18d428
Meredith, Paul
d0a0e287-ad7f-41cb-9347-94d7a0e957c1
Bridges, Jacqueline
57e80ebe-ee5f-4219-9bbc-43215e8363cd
Gould, Gill P.
00cbb1c3-b06d-4b6a-ad32-a48c143d36ae
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b

Fogg, Carole, Meredith, Paul, Bridges, Jacqueline, Gould, Gill P. and Griffiths, Peter (2017) The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study. Age and Ageing. (doi:10.1093/ageing/afx022).

Record type: Article

Abstract

Background
older people with dementia admitted to hospital for acute illness have higher mortality and longer hospital stays compared to those without dementia. Cognitive impairment (CI) is common in older people, and they may also be at increased risk of poor outcomes.

Methods
retrospective observational study of unscheduled admissions aged ≥75 years. Admission characteristics, mortality rates and discharge outcomes were compared between three groups: (i) known dementia diagnosis (DD), (ii) CI but no diagnosis of dementia and (iii) no CI.

Results
of 19,269 admissions (13,652 patients), 19.8% had a DD, 11.6% had CI and 68.6% had neither. Admissions with CI or DD were older and had more females than those with no CI, and were more likely to be admitted through the Emergency Department (88.4% and 90.7%, versus 82.0%) and to medical wards (89.4% and 84.4%, versus 76.8%). Acuity levels at admission were similar between the groups. Patients with CI or DD had more admissions at ‘high risk’ from malnutrition than patients with no CI (28.0% and 33.7% versus 17.5%), and a higher risk of dying in hospital (11.8% [10.5–13.3] and 10.8% [9.8–11.9] versus (6.6% [6.2–7.0])).

Conclusions
the admission characteristics, mortality and length of stay of patients with CI resemble those of patients with diagnosed dementia. Whilst attention has been focussed on the need for additional support for people with dementia, patients with CI, which may include those with undiagnosed dementia or delirium, appear to have equally bad outcomes from hospitalisation.

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More information

Accepted/In Press date: 2 December 2016
e-pub ahead of print date: 25 February 2017
Published date: 1 September 2017

Identifiers

Local EPrints ID: 414784
URI: https://eprints.soton.ac.uk/id/eprint/414784
ISSN: 0002-0729
PURE UUID: 238985b5-57cc-4157-9e87-d136c6005d6f
ORCID for Jacqueline Bridges: ORCID iD orcid.org/0000-0001-6776-736X
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

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Date deposited: 11 Oct 2017 16:31
Last modified: 14 Mar 2019 01:37

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