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

Abstract

AbstractBackgroundIt is estimated that over one‐third of hospitalized older patients have cognitive impairment. Cognitive impairment directly impacts care during and after hospitalization. Recognition of cognitive impairment is important to provide person‐centered care, involve relatives, prevent adverse outcomes, and identify people that need support or diagnostic evaluation for dementia after discharge. Previous studies of medical records suggested under‐recognition of cognitive impairment in hospitalized older patients by healthcare professionals. The aim of this study is to investigate the prevalence of cognitive impairment in hospitalized older patients and the recognition of cognitive impairment by healthcare professionals.MethodA cross‐sectional, observational study was conducted in three university hospitals and ten general hospitals in the Netherlands on a single day in 2022, following a flash mob design. The study was an initiative of Alzheimer Center Groningen as part of ABOARD (A Personalized Medicine Approach for Alzheimer’s Disease). 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. The nurses and physicians that took care of the patient that day were asked whether they thought the patient had cognitive impairment.ResultA total of 1,318 potentially eligible patients were available. Of these patients, 374 (28%) were excluded because they were unable to perform the Mini‐Cog or were isolated, and 187 (14%) were excluded because they were not willing to participate. Finally, a total of 757 patients (58%) were included (median age, 77 years [71‐82]; male, 386 [51%]). Of the included patients, 347 patients (46%) had cognitive impairment. Cognitive impairment was recognized by their nurse in 137 of 323 patients (42%) and by their physician in 156 patients (48%). In 135 patients (42%) cognitive impairment was not recognized by either the nurse or physician.ConclusionCognitive impairment is common in older hospitalized patients, and is poorly recognized by healthcare professionals. This study highlights the need for quality improvement of cognitive impairment recognition to provide person‐centered care.