Fogg Carole, Griffiths Peter, Meredith Paul, Bridges Jackie
Research and Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care, Wessex, UK.
Int J Geriatr Psychiatry. 2018 Jun 26;33(9):1177-97. doi: 10.1002/gps.4919.
To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group.
Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods.
One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all-cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described.
Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes.
总结老年认知障碍住院患者的现有结局知识，包括所报告结局的类型和频率，以及该患者群体所面临的额外风险。
综合文献综述。系统检索了医疗保健文献数据库、报告以及关键网站上的政策文件。采用综合方法对描述老年认知障碍患者住院期间及出院时结局的论文进行了分析和总结。
纳入了104篇文章。确定了一系列结局，包括住院期间和出院时出现的结局。患有痴呆症诊断的老年人在医院死亡、入住养老院、住院时间长以及谵妄、跌倒、脱水、营养状况下降、身体和认知功能衰退以及医院内新发感染等中间结局方面风险更高。较少有研究探讨全因认知障碍与结局之间的关系。患者和照顾者对住院的体验往往较差。很少有研究收集与医院环境相关的数据，如病房类型或人员配备水平，且很少描述疾病的严重程度。
认知障碍老年人在医院发生各种负面结局的风险更高。普遍存在的中间结局表明，需要改变护理流程，以确保维持基本护理服务，并更加关注这一弱势群体的患者安全。需要更多研究来了解实现这一目标的最合适方法，以及如何最好地实施这些护理流程的改变以改善医院结局。
