Abstract

7.5 years) were consecutively admitted to a acute medical ward during a 28-month period. Cognitive status (by Mini-Mental State Examination), social conditions, Charlson Index score, APACHE II score, level of serum albumin, functional status (by IADL and Barthel Index at admission, premorbid and at discharge) were assessed. Impairment of function due to an acute event is measured as the difference between performances on admission and 2 weeks before the acute event. Six-month survival was analysed. Results: 27.8% of elderly admitted in our Acute Medical Unit had a moderate to severe dementia (MMSE 18). Compared to patients with MMSE score greater than 18, demented patients were older (mean age 83.2 6.9 vs 78.8 7.1, p 0001), had a more severe acute condition (APACHE II score 9.7 5.1 vs 8.2 3.4, p 0.001), greater comorbidity (Charlson Index 4.2 .1 vs 3.6 1.9, p 0.001), and lower levels of albumin (3.3 0.6 vs 3.5 0.07, p 0.01). demented patients were more disabled at admission (IADL number of function lost 5.5 2.7 vs 2.5 2.7, p 0.001; BI score 41.1 33.8 vs 72.5 29.2, p 0.001). The acute event had a greater functional influence in demented patients (BI decline 22.5 23.6 vs 15.2 20.0, p 0.001) and functional recovery at discharge was greater (BI recovery 12.8 19.6 vs 9.9 19.7, p 0.02). In-hospital mortality and 6 moths mortality were grater in demented subjects (respectively 3.2% vs 1.4%, p 0.05; and 33.5% vs 18.2%, p 0.01). 23% of demented patients were institutionalized in 6 month, vs 3% of not demented (p 0.001). Conclusions: Demented patients were admitted to acute hospital for more severe conditions than not demented and acute diseases had a great functional impact. In-hospital and 6-months mortality were greater in demented patients.

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