title: Adverse clinical events and mortality during hospitalization and 3 months after discharge in cognitively impaired elderly patients.
abstract: BACKGROUND
  Controversial findings are reported on hospital outcome in cognitively impaired patients. The aim of this study was to explore mortality risk according to cognitive status during hospitalization and after 3 months in elderly patients.
  
  
  METHODS
  Sixty-six internal medicine and geriatric wards in Italy participated in the "Registry Politerapie SIMI (REPOSI)" during 2010. Of the 1,380 in-patients, aged 65 and older enrolled, 1,201 were included. Cognition was evaluated with the Short Blessed Test (SBT). Logistic regression was used to evaluate the association of questionable and impaired cognition (according to SBT cutoff points) with mortality during hospitalization and at follow-up. Morbidity, function, and adverse events during hospitalization were covariates.
  
  
  RESULTS
  Four hundred and twenty-one participants were classified as normal, 219 questionable, and 561 cognitively impaired. Forty-nine patients died during hospitalization and 70 during follow-up. Sixty-seven point three percent versus 32.7% (p < .001) of patients who died during hospitalization and 54.3% versus 45.7% (p < .001) during follow-up had at least one adverse event. After multiadjustment, impaired cognition was associated with in-hospital mortality (odds ratio [OR] = 3.1; 95% confidence interval [CI] = 1.1-8.6) but not with mortality at follow-up. Increase severity of cognitive impairment was associated with higher odds of mortality (from 2.7 in those with moderate impairment to 4.2 in those with severe impairment). After stratification for adverse clinical events, impaired cognition resulted associated with mortality only in patients having at least one event.
  
  
  CONCLUSIONS
  Elderly patients with cognitive impairment are more likely to die during hospitalization with a severity-dependent association. Adverse events may represent an important target of prevention due to their high association with mortality and cognitive impairment.
authors.affiliation: Geriatric Unit, Spedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Italy. alessandra.marengoni@ki.se
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
authors.forename: Valentina
authors.initials: V
authors.lastname: Romano
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Djade
authors.forename: Salvatore
authors.initials: S
authors.lastname: Corrao
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iorio
authors.forename: Maura
authors.initials: M
authors.lastname: Marcucci
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007361:Intelligence Tests; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors