Abstract
BackgroundCognitive spectrum disorders (CSDs) are common in hospitalised older adults and associated with adverse outcomes. Their association with the maintenance of independent living has not been established. The aim was to establish the role of CSDs on the likelihood of living at home 30 days after discharge or being newly admitted to a care home.MethodsA prospective cohort study with routine data linkage was conducted based on admissions data from the acute medical unit of a district general hospital in Scotland. 5570 people aged ≥ 65 years admitted from a private residence who survived to discharge and received the Older Persons Routine Acute Assessment (OPRAA) during an incident emergency medical admission were included.The outcome measures were living at home, defined as a private residential address, 30 days after discharge and new care home admission at hospital discharge. Outcomes were ascertained through linkage to routine data sources.ResultsOf the 5570 individuals admitted from a private residence who survived to discharge, those without a CSD were more likely to be living at home at 30 days than those with a CSD (93.4% versus 81.7%; difference 11.7%, 95%CI 9.7–13.8%). New discharge to a care home affected 236 (4.2%) of the cohort, 181 (76.7%) of whom had a CSD. Logistic regression modelling identified that all four CSD categories were associated with a reduced likelihood of living at home and an increased likelihood of discharge to a care home. Those with delirium superimposed on dementia were the least likely to be living at home (OR 0.25), followed by those with dementia (OR 0.43), then unspecified cognitive impairment (OR 0.55) and finally delirium (OR 0.57).ConclusionsIndividuals with a CSD are at significantly increased risk of not returning home after hospitalisation, and those with CSDs account for the majority of new admissions to care homes on discharge. Individuals with delirium superimposed on dementia are the most affected. We need to understand how to configure and deliver healthcare services to enable older people to remain as independent as possible for as long as possible and to ensure transitions of care are managed supportively.
Highlights
Cognitive spectrum disorders (CSDs) are common in hospitalised older adults and associated with adverse outcomes
Cognitive spectrum disorders (CSD) is a term encompassing diagnosed dementia, delirium, delirium superimposed on known dementia and unspecified cognitive impairment [3]
Of those with CSD, 49.3% (95%CI 46.9–51.7) had delirium alone, 20.0% (95%CI 18.3–22.1) had known dementia, 17.1% (95%CI 15.4–19.0) had delirium superimposed on known dementia and 13.6% (95%CI 12.0– 15.3) had unspecified cognitive impairment (Table 2)
Summary
Cognitive spectrum disorders (CSDs) are common in hospitalised older adults and associated with adverse outcomes. Their association with the maintenance of independent living has not been established. The aim of effective acute hospital care for older people is to assess individual needs, treat modifiable conditions, support functional recovery and facilitate discharge. Cognitive impairment is often unrecognised in the acute hospital setting [4]. Those whose cognitive function worsens in hospital are at particular risk of functional decline as an inpatient [5]. Mortality during and after admission is higher in people with cognitive impairment than those without, and is increased irrespective of the cause of cognitive impairment [6], with mortality 12 months after discharge in our cohort of 40% in older adults with CSD compared to 26% for those without [3]
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