Prevalence and recognition of cognitive impairment in hospitalized older patients: a flash mob study

Abstract

Background: It is estimated that over one-third of hospitalized older patients have cognitive impairment. Cognitive impairment directly impacts care across all disciplines during and after hospitalization. Recognition of cognitive impairment is important to provide integrated, person-centred care, involve relatives and informal caregivers in the care plan, prevent adverse outcomes, and identify people that need support after discharge. However, previous studies of medical records and discharge reviews suggested under-recognition of cognitive impairment in hospitalized patients by healthcare professionals. The aim of this study is to investigate the prevalence of cognitive impairment in hospitalized older patients and recognition of cognitive impairment by healthcare professionals.
 Method: This nationwide, cross-sectional, observational study was conducted in thirteen hospitals in the Netherlands on the 21st of September 2022, following a flash mob design. The study was an initiative of Alzheimer Centre Groningen as part of ABOARD (A Personalized Medicine Approach for Alzheimer’s Disease), which is a public-private partnership. Cognitive impairment, indicated by a Mini-Cog score of <3 (out of 5), was assessed in Dutch-speaking, hospitalized patients aged ≥ 65 years old. Patients were excluded if they were unable to perform the Mini-Cog due to sensory impairment or severe delirium, required medical isolation, or were not willing to participate. On the same day, nurses and physicians that took care of the participating patient were asked whether they thought the patient had cognitive impairment. Since the flash mob design entails working with a large group ‘mob’ of data collectors to answer a relatively simple but relevant research question in a short time ‘flash’, we involved many healthcare education students (e.g. nursing, medicine, applied psychology) and hospital staff (e.g. nurse practitioners, researchers) with data collection. 
 Results: In three university hospitals and ten general hospitals, there were a total of 1,308 potentially eligible patients. Of these patients, 378 (29%) were excluded because they were unable to perform the Mini-Cog or were isolated, and 176 (13%) were excluded because they were not willing to participate. Finally, a total of 754 patients (58%) were included (mean [SD] age, 77 [7.43] years; male [%], 383 [51]). Preliminary data showed that 344 patients (46%) had cognitive impairment. Cognitive impairment was recognized by their nurse in 141 of 344 patients (41%). Cognitive impairment was recognized by their physician in 156 patients (45%). In 104 patients (30%) cognitive impairment was recognized by both their nurse and physician. Final results will follow after completion of data analysis.
 
 Conclusion and discussion: Preliminary data showed that cognitive impairment is common in older hospitalized patients, and is poorly recognized by healthcare professionals. Recognition of cognitive impairment by healthcare professionals needs to be improved to be able to provide integrated and person-centred care, and identify patients that need support from other healthcare providers after discharge. By conducting a flash mob study, by means of involving (future) healthcare professionals with data collection and highlighting the topic among participating hospitals, we may already have raised awareness about cognitive impairment in hospitalized older patients.