Aims. To determine: (1) rates of documentation of Cognitive Impairment (CI) screening in hospitalised patients ³65 years; (2) factors associated with having CI screening; (3) rates of undocumented CI; (4) presence of care-planning documents in clinical record; (5) factors associated with presence of care-planning documents and (6) healthcare provider perceptions to CI screening.
Methods. A Clinical record audit at a public hospital in New South Wales of inpatients ³65 years admitted for a minimum of 48hrs. Patient demographics, presence of CI screening and advanced care planning documentation were extracted. Patients not screened for CI were administered the Montreal Cognitive Assessment (MoCA) to determine cognitive status. Interviews were conducted with healthcare providers to understand their practices of screening for CI.
Results. Of the 165 patients audited, 34.5% (n=57) had screening for CI documented. Patients aged >85 years and those with ³2 admissions had greater odds of having CI screening. Among patients without CI screening documented, 72% (n=78) were identified as cognitively impaired using the MoCA. Few patients had a substitute decision maker (9.1%, n=15) or resuscitation plan (34.5%, n=57) documented. Those aged >85 years were 3.53 times more likely to have care planning documented (95% CI: 1.34, 9.29, p=0.01). Interviewed healthcare professionals all agreed CI screening was beneficial, however identified time and knowledge as barriers for screening.
Conclusions. CI is frequently unrecognised in hospitals which is a missed opportunity for providing appropriate care. Further research is required to identify effective strategies to increase CI screening and advanced care planning in hospital.