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

The prevalence of recognised cognitive impairment in older adults attending the diabetes clinic (#190)

Tessa O'Halloran 1 2 , Rosie Watson 1 3 4 , Mervyn Kyi 3 5
  1. Department of Aged Care, Royal Melbourne Hospital, Parkville, VIC
  2. Department of Aged Care, Monash Health, Melbourne, VIC
  3. Department of Medicine, Royal Melbourne Hospital, Parkville, VIC
  4. Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC
  5. Department of Endocrinology, Royal Melbourne Hospital, Parkville, VIC

Aims: To determine the prevalence of recognised cognitive impairment amongst older adults attending a hospital-based diabetes clinic

 

Methods: This was a single centre retrospective cross-sectional study, in collaboration with the diabetes clinic of a tertiary metropolitan hospital. Stakeholder meetings identified a database of routinely collected patient information, wherein recognised cognitive impairment would be recorded. This data was obtained for all adults aged over 60 years old who attended the clinic from March 1 to August 1, 2020. Duplicate attendances were removed. Both an automated and manual search was undertaken to identify any record of cognitive impairment. Extracted data were analysed using simple descriptive statistics.

 

Results: Of 582 older adults, there were 6 (1.02%) patients with recognised cognitive impairment (table 1). The recorded diagnoses were: “dementia” (n=4), “cognitive impairment” (n=1), and Lewy Body Dementia (n=1). Concerns related to memory or cognition were noted in a further 8 patients, that did not constitute a recognised diagnosis (table 2). There were no recorded instances of mild cognitive impairment. Between-group comparisons were not possible due to the unexpectedly low prevalence of cognitive impairment identified.

 

Conclusions: Cognitive impairment was recognised less frequently than expected in older adults attending the diabetes clinic. Compared with the expected prevalence (between 29% and 74%[1-4]), this suggests a large pool of adults with unrecognised cognitive impairment. This presents a rich opportunity for quality improvement, and supports the case for routine screening for cognitive impairment amongst older adults attending the diabetes clinic. Based on evidence-based models of geriatrician-led collaboration in other specialty areas[5-11], a possible screening pathway is outlined (figure 1).

 

 

 

Tables and figures

 

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 63f7fae9bc533-Figure+1+pathway.png

 

 

  1. Gao, Y., et al., The prevalence of mild cognitive impairment with type 2 diabetes mellitus among elderly people in China: A cross-sectional study. Archives of gerontology and geriatrics, 2016. 62: p. 138-42.
  2. Bruce, D.G., et al., Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: the Fremantle Cognition in Diabetes Study. Diabetes research and clinical practice, 2003. 61(1): p. 59-67.
  3. Munkhsukh, M.-U., et al., Dementia risk among Mongolian population with type 2 diabetes: a matched case-control study. Journal of integrative neuroscience, 2021. 20(3): p. 659-666.
  4. Panyawattanakit, C., et al., Cognitive Impairment and Associated Factors among Older Adults with Diabetes in a Suburban Primary Health Center in Thailand. Dementia & Geriatric Cognitive Disorders, 2022. 51(2): p. 175-181.
  5. Harari, D., et al., Proactive care of older people undergoing surgery ('POPS'): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing, 2007. 36(2): p. 190-6.
  6. Hamaker, M.E., et al., The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients - A systematic review. J Geriatr Oncol, 2018. 9(5): p. 430-440.
  7. Mulligan, A., et al., Cardio-geriatric model of care in acute heart failure: initial experience of a multidisciplinary approach in complex elderly patients. Intern Med J, 2020. 50(4): p. 488-492.
  8. Wallis, M., et al., The Geriatric Emergency Department Intervention model of care: a pragmatic trial. BMC Geriatr, 2018. 18(1): p. 297.
  9. Lenartowicz, M., et al., An evaluation of a proactive geriatric trauma consultation service. Ann Surg, 2012. 256(6): p. 1098-101.
  10. Grigoryan, K.V., H. Javedan, and J.L. Rudolph, Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma, 2014. 28(3): p. e49-55.
  11. Partridge, J.S., et al., Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg, 2017. 104(6): p. 679-687.