Research Abstract: Advanced Trainee - Oral Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

Rates of Unrecognised Cognitive Impairment in Hospitalised Older Patients at Discharge (#80)

Arthur Chee 1 2 3 , Peter N Gonski 3 4 , Nicholas J Cordato 1 2 3
  1. Aged Care Department, St George Public Hospital, Sydney, NSW, Australia
  2. Aged Care Department, Calvary Health Care Kogarah, Sydney, NSW, Australia
  3. University of New South Wales, Sydney, NSW, Australia
  4. Southcare Aged Care Department, The Sutherland Hospital, Sydney, Australia

Aims

Cognitive impairment (CI), often due to dementia, or impairment from delirium impacts on discharge planning. The primary aim is to determine whether CI is being routinely identified in acutely hospitalised, older patients by the time of hospital discharge. The secondary aim is to assess if there are changes in performance on screening cognitive tests two weeks following hospitalisation.

 

Methods

Seventy-four patients aged 65 years or older, without a diagnosis of dementia, were sequentially recruited from two metropolitan hospitals. A Folstein Mini-Mental-State-Examination (MMSE) and 4A’s test were conducted at discharge. Data on accommodation and services being received upon admission were also collected. A follow-up telephone interview was conducted two weeks post‑discharge, with the Modified-Telephone-Interview for Cognitive Status (TICS‑M) and the Ultra‑Brief Two-Item-Test for Delirium. Data was also collected on discharge destination and services organised. Services on admission and discharge and results of the MMSE and TICS-M were quantitatively compared.


Results

No participants underwent routine cognitive screening with a standardised tool whilst hospitalised. Thirty-five participants scored <24/30 on the MMSE upon discharge; thirty-two had no prior clinical diagnosis of CI. Twenty-three of these participants received enhanced services at discharge (Figure 1). At follow‑up, only 11 of these participants with CI on the MMSE demonstrated normalised scores on the “CHeBA-TICS-M-Norms Calculator”1 consistent with CI. This may reflect persisting delirium.

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Conclusions

CI is not routinely identified in geriatric patients at hospital discharge. However, the majority of patients with potential CI received increased assistance at discharge, consistent with recognition of their increased functional needs.

  1. Bentvelzen AC, Crawford JD, Theobald A, Maston K, Slavin MJ, Reppermund S, et al. Validation and normative data for the modified telephone interview for cognitive status: The Sydney memory and ageing study. Journal of the American Geriatrics Society. 2019;67(10):2108-15.