title: Impact and recognition of cognitive impairment among hospitalized elders.
abstract: BACKGROUND
  Older adults are predisposed to developing cognitive deficits. This increases their vulnerability for adverse health outcomes when hospitalized.
  
  
  OBJECTIVE
  To determine the prevalence and impact of cognitive impairment (CI) among hospitalized elders based on recognition by lCD-coding versus screening done on admission.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Urban public hospital in Indianapolis.
  
  
  METHODS
  997 patients age 65 and older admitted to medical services between July 2006 and March 2008.
  
  
  METHODS
  Impact of CI in terms of length of stay, survival, quality of care and prescribing practices. Cognition was assessed by the Short Portable Mental Status Questionnaire (SPMSQ).
  
  
  RESULTS
  424 patients (43%) were cognitively impaired. Of those 424 patients with CI, 61% had not been recognized by ICD-9 coding. Those unrecognized were younger (mean age 76.1 vs. 79.1, P <0.001); had more comorbidity (mean Charlson index of 2.3 vs.1.9, P = 0.03), had less cognitive deficit (mean SPMSQ 6.3 vs. 3.4, P < 0.001). Among elders with CI, 163 (38%) had at least one day of delirium during their hospital course. Patients with delirium stayed longer in the hospital (9.2 days vs. 5.9, P < 0.001); were more likely to be discharged into institutional settings (75% vs. 31%, P < 0.001) and more likely to receive tethers during their care (89% vs. 69%, P < 0.001), and had higher mortality (9% vs. 4%, P = 0.09).
  
  
  CONCLUSIONS
  Cognitive impairment, while common in hospitalized elders, is under-recognized, impacts care, and increases risk for adverse health outcomes.
authors.affiliation: Indiana University Center for Aging Research, Indiana University, Indianapolis, Indiana, USA. mboustani@regenstrief.org
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.forename: Mary Shearer
authors.initials: MS
authors.lastname: Baker
authors.forename: Noll
authors.initials: N
authors.lastname: Campbell
authors.forename: Stephanie
authors.initials: S
authors.lastname: Munger
authors.forename: Siu L
authors.initials: SL
authors.lastname: Hui
authors.forename: Pete
authors.initials: P
authors.lastname: Castelluccio
authors.forename: Mark
authors.initials: M
authors.lastname: Farber
authors.forename: Oscar
authors.initials: O
authors.lastname: Guzman
authors.forename: Adetayo
authors.initials: A
authors.lastname: Ademuyiwa
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.forename: Chris
authors.initials: C
authors.lastname: Callahan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D015331:Cohort Studies; D003693:Delirium; D011307:Drug Prescriptions; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007196:Indiana; D007297:Inpatients / Q000523:psychology*; D007902:Length of Stay; D008297:Male; D019370:Observation; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013534:Survival