Indiana University Center for Aging Research, Indiana University, Indianapolis, Indiana, USA.
J Hosp Med. 2010 Feb;5(2):69-75. doi: 10.1002/jhm.589.
Older adults are predisposed to developing cognitive deficits. This increases their vulnerability for adverse health outcomes when hospitalized.
To determine the prevalence and impact of cognitive impairment (CI) among hospitalized elders based on recognition by lCD-coding versus screening done on admission.
Observational cohort study.
Urban public hospital in Indianapolis.
997 patients age 65 and older admitted to medical services between July 2006 and March 2008.
Impact of CI in terms of length of stay, survival, quality of care and prescribing practices. Cognition was assessed by the Short Portable Mental Status Questionnaire (SPMSQ).
424 patients (43%) were cognitively impaired. Of those 424 patients with CI, 61% had not been recognized by ICD-9 coding. Those unrecognized were younger (mean age 76.1 vs. 79.1, P <0.001); had more comorbidity (mean Charlson index of 2.3 vs.1.9, P = 0.03), had less cognitive deficit (mean SPMSQ 6.3 vs. 3.4, P < 0.001). Among elders with CI, 163 (38%) had at least one day of delirium during their hospital course. Patients with delirium stayed longer in the hospital (9.2 days vs. 5.9, P < 0.001); were more likely to be discharged into institutional settings (75% vs. 31%, P < 0.001) and more likely to receive tethers during their care (89% vs. 69%, P < 0.001), and had higher mortality (9% vs. 4%, P = 0.09).
Cognitive impairment, while common in hospitalized elders, is under-recognized, impacts care, and increases risk for adverse health outcomes.
老年人易发生认知功能障碍，这增加了他们住院期间健康状况恶化的脆弱性。
根据 ICD 编码识别与入院时进行的筛查，确定住院老年人认知障碍（CI）的患病率和影响。
观察性队列研究。
印第安纳波利斯市的一家城市公立医院。
2006 年 7 月至 2008 年 3 月期间入住医疗服务的 997 名 65 岁及以上的患者。
CI 对住院时间、生存、护理质量和开处方实践的影响。认知能力通过简短便携式精神状态问卷（SPMSQ）进行评估。
424 名患者（43%）认知受损。在 424 名有 CI 的患者中，61%未被 ICD-9 编码识别。这些未被识别的患者年龄较小（平均年龄 76.1 岁 vs. 79.1 岁，P <0.001）；合并症更多（平均 Charlson 指数为 2.3 分 vs. 1.9 分，P = 0.03）；认知缺陷更少（平均 SPMSQ 为 6.3 分 vs. 3.4 分，P < 0.001）。在有 CI 的老年人中，163 人（38%）在住院期间至少有一天谵妄。谵妄患者住院时间更长（9.2 天 vs. 5.9 天，P < 0.001）；更有可能被安置到机构中（75% vs. 31%，P < 0.001）；在护理过程中更有可能接受约束（89% vs. 69%，P < 0.001），死亡率更高（9% vs. 4%，P = 0.09）。
认知障碍在住院老年人中很常见，但未得到充分认识，会影响护理，并增加不良健康结果的风险。
