Cognitive impairment in older hospital inpatients: prevalence, care needs and carer perceptions
Alison M. Mudge A B , Karen Lee-Steere A C , Elise Treleaven A , Margaret Cahill A , Simon Finnigan D E and Prue McRae AA Internal Medicine Research Unit, Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Herston, Qld, Australia. Email: Elise.Treleaven@health.qld.gov.au; Karen.Lee-Steere@health.qld.gov.au; Margaret.Cahill@health.qld.gov.au; prue.mcrae@health.qld.gov.au
B School of Clinical Medicine, The University of Queensland, Herston, Qld, Australia.
C Faculty of Health and Biomedical Sciences, The University of Queensland, St Lucia, Qld, Australia.
D Centre for Functioning and Health Research, Metro South Hospitals and Health Service, Buranda, Qld, Australia. Email: finnigan@uq.edu.au
E Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia.
F Corresponding author. Email: Alison.Mudge@health.qld.gov.au
Australian Health Review 46(2) 244-250 https://doi.org/10.1071/AH20286
Submitted: 5 October 2020 Accepted: 15 April 2021 Published: 3 December 2021
Abstract
Objectives The aim of this study was to describe the prevalence of cognitive impairment in hospital inpatients, the associated need for assistance with activities of daily living (ADL) and carer perceptions of hospital care.
Methods A prospective cross-sectional observational study was conducted in a large metropolitan teaching hospital in Brisbane, Australia. Participants were inpatients aged ≥65 years and their carers. Cognitive impairment was measured by clinician auditors using the validated 4 ‘A’s test (4AT), with a score >0 indicating cognitive impairment (1–3, probable dementia; >3, probable delirium). The need for supervision and/or assistance with ADL was recorded from daily nursing documentation. Carers were invited to complete a brief questionnaire.
Results In all, 92 of 216 older inpatients (43%) had cognitive impairment, including 52 (24%) with probable delirium. The need for supervision and/or assistance with ADL increased significantly with 4AT score. Fifty-two carers of patients with cognitive impairment reported feeling welcome and that care was safe. They identified opportunities for better information, greater support and more inclusion of carers.
Conclusions Cognitive impairment is common in older inpatients and is associated with increased care needs. Workforce planning and health professional training need to acknowledge the needs of patients with cognitive impairment. There are opportunities for greater support and more involvement of carers.
What is known about the topic? Cognitive impairment due to delirium and dementia increases with age, and is common in older medical and surgical inpatients. However, cognitive impairment remains under-recognised by healthcare staff. Australian guidelines now recommend routine screening using valid tools, and including carers, when appropriate, when assessing, caring for and communicating with people with cognitive impairment.
What does this paper add? This cross-sectional study using the validated 4AT showed 43% of hospital inpatients aged ≥65 years had cognitive impairment. Participants with cognitive impairment had higher care needs and much longer hospitalisations. Carers of people with cognitive impairment reported unmet information needs in hospital and had limited involvement in assessment and care.
What are the implications for practitioners? Cognitive impairment is common in older inpatients. Hospitals and healthcare professionals must be prepared and equipped to recognise cognitive impairment, and address the accompanying patient and carer needs.
Keywords: aging, carers, cognitive impairment, hospital care, older inpatients, delirium, activities of daily living, screening tools.
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