title: Cognitive status and behavioral problems in older hospitalized patients.
abstract: OBJECTIVES: (a) To determine the quantity and quality of behavioral problems in older hospitalized patients on acute care units; (b) to determine the burden of these behaviors on staff; and (c) to identify predictors of behavioral problems. METHODS: Upon admission, patients performed the Mini-Mental State Exam (MMSE), the Geriatric Depression Scale (GDS), and information was obtained on age, ethnicity, level of education, living arrangement, and psychiatric history. Two days post-admission, a clinical staff member caring for each patient, performed the Neuropsychiatric Inventory-Questionnaire (NPI-Q) to assess patients' behavioral problems and staff distress. PARTICIPANTS AND SETTING : Forty-two patients, over 60 years of age, admitted to medical and surgical units of the Veterans Affairs Hospitals in Palo Alto and San Francisco, participated. RESULTS: Twenty-three of 42 (55%) patients exhibited behavioral problems. Anxiety, depression, irritability, and agitation/aggression were the most frequently observed behaviors. The severity of the behavioral problems was significantly correlated with staff distress. Lower performance on the MMSE at admission was significantly associated with higher NPI-Q ratings. Specifically, of those cases with scores less than or equal to 27 on the MMSE, 66% had behavioral problems during hospitalization, compared to only 31% of those with scores greater than 27. CONCLUSION: Behavioral problems in older hospitalized patients appear to occur frequently, are a significant source of distress to staff, and can result in the need for psychiatric consultation. Assessment of the mental status of older adults at admission to hospital may be valuable in identifying individuals at increased risk for behavioral problems during hospitalization.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, United States. roh@stanford.edu
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Hara
authors.forename: Martin S
authors.initials: MS
authors.lastname: Mumenthaler
authors.forename: Helen
authors.initials: H
authors.lastname: Davies
authors.forename: Erin L
authors.initials: EL
authors.lastname: Cassidy
authors.forename: Martha
authors.initials: M
authors.lastname: Buffum
authors.forename: Sarojini
authors.initials: S
authors.lastname: Namburi
authors.forename: Roxanne
authors.initials: R
authors.lastname: Shakoori
authors.forename: Claire E
authors.initials: CE
authors.lastname: Danielsen
authors.forename: Patricia
authors.initials: P
authors.lastname: Tsui
authors.forename: Art
authors.initials: A
authors.lastname: Noda
authors.forename: Helena C
authors.initials: HC
authors.lastname: Kraemer
authors.forename: Javaid I
authors.initials: JI
authors.lastname: Sheikh