Epidemiology and outcomes of people with dementia, delirium and unspecified cognitive impairment in the general hospital

prospective cohort study of 10,014 admissions

Emma L. Reynish (Lead / Corresponding author), Simona M. Hapca, Nicosha De Souza, Vera Cvoro, Peter T. Donnan, Bruce Guthrie

    Research output: Contribution to journalArticle

    27 Citations (Scopus)
    89 Downloads (Pure)

    Abstract

    Background: Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission.
    Methods: Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined ‘cognitive spectrum disorder’ (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes.
    Results: A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8% had delirium superimposed. Outcomes were worse in those with CSD compared to those without – LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (all P < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year.
    Conclusions: CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on conditionspecific pathways such as those for dementia or delirium alone
    Original languageEnglish
    Article number140
    Pages (from-to)1-12
    Number of pages12
    JournalBMC Medicine
    Volume15
    DOIs
    Publication statusPublished - 27 Jul 2017

    Fingerprint

    Delirium
    General Hospitals
    Dementia
    Epidemiology
    Cohort Studies
    Prospective Studies
    Length of Stay
    Intelligence Tests
    Mortality
    Emergencies
    Cognitive Dysfunction
    Inpatients
    Cross-Sectional Studies
    Outcome Assessment (Health Care)
    Delivery of Health Care

    Keywords

    • Dementia
    • Delirium
    • Cognitive Impairment
    • Length of Stay
    • Mortality
    • Readmission

    Cite this

    @article{8790e140f4d04527a3293f48eb44d2d4,
    title = "Epidemiology and outcomes of people with dementia, delirium and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions",
    abstract = "Background: Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission.Methods: Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined ‘cognitive spectrum disorder’ (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes.Results: A CSD was present in 38.5{\%} of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7{\%} of older people admitted had delirium alone, 7.9{\%} delirium superimposed on known dementia, 9.4{\%} known dementia alone, and 4.5{\%} unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8{\%} had delirium superimposed. Outcomes were worse in those with CSD compared to those without – LOS 25.0 vs. 11.8 days, 30-day mortality 13.6{\%} vs. 9.0{\%}, 1-year mortality 40.0{\%} vs. 26.0{\%}, 1-year death or readmission 62.4{\%} vs. 51.5{\%} (all P < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year.Conclusions: CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on conditionspecific pathways such as those for dementia or delirium alone",
    keywords = "Dementia, Delirium, Cognitive Impairment, Length of Stay, Mortality, Readmission",
    author = "Reynish, {Emma L.} and Hapca, {Simona M.} and {De Souza}, Nicosha and Vera Cvoro and Donnan, {Peter T.} and Bruce Guthrie",
    note = "OPRAA development and data collection was funded by the Scottish Government Joint Improvement Team, initial data transfer by an NHS Fife R&D Bursary and analysis by the National Institutes for Health Research Health Services and Delivery Research Programme (NIHR HS&DR 13/54/55).",
    year = "2017",
    month = "7",
    day = "27",
    doi = "10.1186/s12916-017-0899-0",
    language = "English",
    volume = "15",
    pages = "1--12",
    journal = "BMC Medicine",
    issn = "1741-7015",
    publisher = "Springer Verlag",

    }

    Epidemiology and outcomes of people with dementia, delirium and unspecified cognitive impairment in the general hospital : prospective cohort study of 10,014 admissions. / Reynish, Emma L. (Lead / Corresponding author); Hapca, Simona M.; De Souza, Nicosha; Cvoro, Vera; Donnan, Peter T.; Guthrie, Bruce.

    In: BMC Medicine, Vol. 15, 140, 27.07.2017, p. 1-12.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Epidemiology and outcomes of people with dementia, delirium and unspecified cognitive impairment in the general hospital

    T2 - prospective cohort study of 10,014 admissions

    AU - Reynish, Emma L.

    AU - Hapca, Simona M.

    AU - De Souza, Nicosha

    AU - Cvoro, Vera

    AU - Donnan, Peter T.

    AU - Guthrie, Bruce

    N1 - OPRAA development and data collection was funded by the Scottish Government Joint Improvement Team, initial data transfer by an NHS Fife R&D Bursary and analysis by the National Institutes for Health Research Health Services and Delivery Research Programme (NIHR HS&DR 13/54/55).

    PY - 2017/7/27

    Y1 - 2017/7/27

    N2 - Background: Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission.Methods: Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined ‘cognitive spectrum disorder’ (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes.Results: A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8% had delirium superimposed. Outcomes were worse in those with CSD compared to those without – LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (all P < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year.Conclusions: CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on conditionspecific pathways such as those for dementia or delirium alone

    AB - Background: Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission.Methods: Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined ‘cognitive spectrum disorder’ (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes.Results: A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8% had delirium superimposed. Outcomes were worse in those with CSD compared to those without – LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (all P < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year.Conclusions: CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on conditionspecific pathways such as those for dementia or delirium alone

    KW - Dementia

    KW - Delirium

    KW - Cognitive Impairment

    KW - Length of Stay

    KW - Mortality

    KW - Readmission

    U2 - 10.1186/s12916-017-0899-0

    DO - 10.1186/s12916-017-0899-0

    M3 - Article

    VL - 15

    SP - 1

    EP - 12

    JO - BMC Medicine

    JF - BMC Medicine

    SN - 1741-7015

    M1 - 140

    ER -