title: The association between an ultrabrief cognitive screening in older adults and hospital outcomes.
abstract: BACKGROUND
  Though often recommended, hospital cognitive assessment is infrequently completed due to clinical and time constraints.
  
  
  OBJECTIVE
  This analysis aimed to evaluate the relationship between performance on ultrabrief cognitive screening instruments and hospital outcomes.
  
  
  METHODS
  This is a secondary data analysis of a quality improvement project.
  
  
  METHODS
  Tertiary Veterans Administration hospital in New England.
  
  
  METHODS
  Patients, ≥ 60 years old, admitted to the hospital.
  
  
  METHODS
  None.
  
  
  METHODS
  Upon admission, patients were administered 2 cognitive screening tools. The modified Richmond Agitation and Sedation Scale (mRASS) is a measure of arousal that can be completed in 15 seconds. The months of the year backward (MOYB) is a measure of attention that can be administered in ≤1 minute. In-hospital outcomes included restraints and mortality, whereas discharge outcomes included length of stay, discharge not home, and variable direct costs. Risk ratios were calculated for dichotomous outcomes and unadjusted Poisson regression for continuous outcomes.
  
  
  RESULTS
  Patients (n = 3232) were screened. Altered arousal occurred in 15% of patients (n = 495); incorrect MOYB was recorded in 45% (n = 1457). Relative to those with normal arousal and attention, those with abnormal mRASS and incorrect MOYB had increased length of stay (incident rate ratio [IRR]: 1.23, 95% confidence interval [CI]: 1.17-1.30); restraint use (risk ratio [RR]: 5.05, 95% CI: 3.29-7.75), in-hospital mortality (RR: 3.46, 95% CI: 1.24-9.63), and decreased discharge home (RR: 2.97, 95% CI: 2.42-3.64). Hospital variable direct costs were slightly, but not significantly, higher (IRR: 1.02, 95% CI: 0.88-1.17).
  
  
  CONCLUSIONS
  Impaired performance on ultrabrief cognitive assessments of arousal and attention provide valuable insights regarding hospital outcomes.
authors.affiliation: College of Nursing, The Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Yevchak
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Kelly
authors.initials: K
authors.lastname: Doherty
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Archambault
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.|School of Nursing, Science and Health Professions, Regis College, Boston, Massachusetts.
authors.forename: Brittany
authors.initials: B
authors.lastname: Kelly
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.|Department of Epidemiology, Boston University, Boston, Massachusetts.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Fonda
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.|Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care / Q000379:methods*; D058996:Quality Improvement; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs