A - 47 Characteristics and Outcomes of Older Inpatients Undergoing Neuropsychological Assessment of their Lifestyle Decision-Making Capacity.

Abstract

Assessments of older inpatients' capacity to make life-style decisions (lifestyle decision-making capacity; LS-DMC) are in high demand due to the increasing prevalence of neurodegenerative disorders and cognitive decline. Few studies have compared the characteristics and outcomes of inpatients who lack LS-DMC with those that don't. Older inpatients (≥60years) underwent neuropsychological assessment (n = 124) and were categorized as either lacking (64%) or not-lacking (36%) LS-DMC. The two groups were compared on information available to referring medical practitioners (demographics, living supports, medical history, Mini-Mental Status Examination; MMSE, and Frontal Assessment Battery; FAB) and the QuickSort cognitive screen. Inpatients' need for legal hearings to resolve lifestyle decisions and additional living supports, and length of hospital stay and readmissions within 1-year were also investigated. The QuickSort differentiated between inpatients who lacked/didn't-lack LS-DMC better than the MMSE, FAB, and other demographic and medical information. Most inpatients who lacked LS-DMC needed additional living supports (92%), with 71% discharged to live in supported care or with family. Length of hospitalization (M = 49.4 SD = 37.8) and 1-year readmission rates (62%) were comparable for both groups. Of the 40% of inpatients requiring legal hearings, most lacked LS-DMC (55%), refused additional living-supports (88%), had surrogate decision-makers appointed (73%), and were hospitalized longer (M = 61.5 SD = 34.1). The QuickSort provided a more accurate and briefer screen for LS-DMC than the MMSE, FAB and other patient information, suggesting it might be useful for the early detection of inpatients who may lack LS-DMC and need additional living supports, legal hearings to resolve lifestyle decisions and extended hospitalizations.