New diagnoses of dementia among older patients admitted to postacute care.
OBJECTIVE
To determine the prevalence of dementia and the proportion of undiagnosed dementia in elderly patients admitted to postacute care, and to identify patients' characteristics associated with undiagnosed dementia.


METHODS
Cross-sectional study.


METHODS
Academic postacute rehabilitation facility in Lausanne, Switzerland.


METHODS
Patients (N=1764) aged 70 years and older.


METHODS
Data on socio-demographic, medical, functional, and affective status were collected upon admission. Data on cognitive performance (Mini-Mental State Exam [MMSE]), and cognition-related discharge diagnoses were abstracted through a structured review of discharge summaries.


RESULTS
Overall, 24.1% (425/1764) patients had a diagnosis of dementia, most frequently secondary to Alzheimer's disease (260/425, 61.2%). Among dementia cases, 70.8% (301/425) were newly diagnosed during postacute stay. This proportion was lower among patients referred from internal medicine than from orthopedic/surgery services (65.8% versus 74.8%, P=.042). Compared to patients with already diagnosed dementia, those newly diagnosed were older, lived alone more frequently, and had better functional status and MMSE score at admission (all P < .05). In multivariate analysis, previously undetected dementia remained associated with older age (OR=2.4 for age 85 years and older, 95% CI 1.5-4.0, P=.001) and normal MMSE at admission (OR=5.9, 95% CI 2.7-12.7, P < .001).


CONCLUSIONS
Dementia was present in almost a fourth of elderly patients referred to postacute care, but was diagnosed in less than a third before admission. Oldest old patients appear especially at risk for underrecognition. These results emphasize the high diagnostic yield of systematic cognitive assessment in the postacute care setting to improve these patients' management and quality of life.
Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland.
Michele
M
Ferretti
Laurence
L
Seematter-Bagnoud
Estelle
E
Martin
Christophe J
CJ
Büla
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D012047:Rehabilitation Centers; D013557:Switzerland / Q000453:epidemiology