Cognitive impairment in elderly medical inpatients: detection and associated six-month outcomes.
OBJECTIVE
The authors examined the relationship of cognitive impairment at hospital admission to 6-month outcome (hospital readmission, nursing home admission, and death) in a cohort of elderly medical inpatients.


METHODS
A group of 401 medical inpatients age 75 and older underwent a comprehensive geriatric assessment at hospital admission and were followed up for 6 months. Cognitive impairment was defined as a score <24 on the Mini-Mental State Exam. Detection was assessed through blinded review of discharge summary. Follow-up data were gathered from the centralized billing system (hospital and nursing home admissions) and from proxies (death).


RESULTS
Cognitive impairment was present in 129 patients (32.3%). Only 48 (37.2%) were detected; these had more severe impairment than undetected cases. During follow-up, cognitive impairment, whether detected or not, was associated with death and nursing home admission. After adjustment for health, functional, and socioeconomic status, an independent association remained only for nursing home admission in subjects with detected impairment. Those with undetected impairment appeared to be at intermediate risk, but this relationship was not statistically significant.


CONCLUSIONS
In these elderly medical inpatients, cognitive impairment was frequent, rarely detected, and associated with nursing home admission during follow-up. Although this association was stronger in those with detected impairment, these results support the view that acute hospitalization presents an opportunity to better detect cognitive impairment in elderly patients and target further interventions to prevent adverse outcomes such as nursing home admission.
Joray
Sabine
S
Division of Geriatric Medicine, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Wietlisbach
Vincent
V
Büla
Christophe J
CJ
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000401:mortality; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011594:Psychometrics; D016019:Survival Analysis