Causes of Hospital Admission for People With Dementia: A Systematic Review and Meta-Analysis

Toot, Sandeep; Devine, Mike; Akporobaro, Ajiri; Orrell, Martin

doi:10.1016/j.jamda.2013.01.011

Cited by 113 publications

(116 citation statements)

References 11 publications

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“…Here the evidence is mostly circumstantial. (10) Cognitive impairment is a risk factor for adverse life events and hospitalization,(27,30–32) so cognitive screening may change the cost-benefit calculus of surgery by helping identify those least likely to benefit from the procedure. Failure to recognize the problem could lead to suboptimal outcomes in a surgical setting if patients cannot recall what is expected of them pre- or postoperatively in terms of medication regimens, activity restrictions, wound care, and rehabilitation, and one cannot rely on routine clinical interactions to detect cognitive impairment or even frank dementia.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Culley

Flaherty

Reddy

et al. 2016

Anesthesia &Amp; Analgesia

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Background Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. Methods We approached 311 patients ≥ 65 years-old presenting for preoperative evaluation prior to elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible and 63 declined. The remaining 200 were randomized to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5. Results The age of consenting patients was 73.7± 6.4 (mean ± SD) years. There were no significant differences between patients randomized to the Mini-Cog or CIB test in age, weight, gender, education, ASA physical status or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P =1.0 by Chi Square analysis). Both tests had good inter-rater reliability (Krippendroff's alpha = 0.86 (0.72–0.93) for Mini-Cog and 1 (1-1) for CIB). Conclusions Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.

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Section: Discussionmentioning

confidence: 99%

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Culley

Flaherty

Reddy

et al. 2016

Anesthesia &Amp; Analgesia

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“…A recent systematic review and meta-analysis found that behavioural problems (including agitation and wandering) and ADLs were associated with higher risk of hospitalisation for people with dementia. 36 Cognitive impairment is a significant predictor of care home and general hospital admissions, and of the overall risk of institutionalisation, but-as discussed below-other individual characteristics are also important. Some cost differences are revealed when we look at our selected MMSE 'case values'.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register

et al. 2016

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ObjectivesTo examine links between clinical and other characteristics of people with Alzheimer's disease living in the community, likelihood of care home or hospital admission, and associated costs.DesignObservational data extracted from clinical records using natural language processing and Hospital Episode Statistics. Statistical analyses examined effects of cognition, physical health, mental health, sociodemographic factors and living circumstances on risk of admission to care home or hospital over 6 months and associated costs, adjusting for repeated observations.SettingCatchment area for South London and Maudsley National Health Service Foundation Trust, provider for 1.2 million people in Southeast London.ParticipantsEvery individual with diagnosis of Alzheimer's disease seen and treated by mental health services in the catchment area, with at least one rating of cognition, not resident in care home at time of assessment (n=3075).InterventionsUsual treatment.Main outcome measuresRisk of admission to, and days spent in three settings during 6-month period following routine clinical assessment: care home, mental health inpatient care and general hospital inpatient care.ResultsPredictors of probability of care home or hospital admission and/or associated costs over 6 months include cognition, functional problems, agitation, depression, physical illness, previous hospitalisations, age, gender, ethnicity, living alone and having a partner. Patterns of association differed considerably by destination.ConclusionsMost people with dementia prefer to remain in their own homes, and funding bodies see this as cheaper than institutionalisation. Better treatment in the community that reduces health and social care needs of Alzheimer's patients would reduce admission rates. Living alone, poor living circumstances and functional problems all raise admission rates, and so major cuts in social care budgets increase the risk of high-cost admissions which older people do not want. Routinely collected data can be used to reveal local patterns of admission and costs.

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“…Copyright © SLACK Incorporated cne ARTICLE iors, physiological instability, and safety concerns result in increased risk of hospitalizations (Callahan et al, 2012;Toot, Devine, Akporobaro, & Orrell, 2013). In the hospital, staff often confront behavioral challenges, for which little formal training is provided.…”

mentioning

confidence: 99%

Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia

Marx¹,

Stanley²,

Haitsma³

et al. 2014

J Gerontol Nurs

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ARTICLEHOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE Instructions 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certifi cate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must:1. Read the article, "Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia" found on pages 26-34, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certifi cate will be automatically generated.This activity is valid for continuing education credit until November 30, 2016. Contact HoursThis activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Activity Objectives1. Discuss the learning needs of staff on a dementia care unit.2. Describe challenging behaviors that occur in patients with dementia. Disclosure StatementNeither the planners nor the authors have any confl icts of interest to disclose. of Gerontological Nursing, 40(12),[26][27][28][29][30][31][32][33][34] 26Copyright © SLACK Incorporated cne ARTICLE iors, physiological instability, and safety concerns result in increased risk of hospitalizations (Callahan et al., 2012;Toot, Devine, Akporobaro, & Orrell, 2013). In the hospital, staff often confront behavioral challenges, for which little formal training is provided. Common behavioral challenges include medication refusal, rejection of needed assistance, fearfulness of medical procedures, heightened confusion, agitation, and verbal/ physical aggression toward staff (Galvin et al., 2010).Managing behaviors is associated with low job satisfaction and burnout (Brodaty, Draper, & Low, 2003;Miyamoto, Tachimori, & Ito, 2010 Dementia, 2014;Sadowsky & Galvin, 2012). Although nonpharmacological approaches to managing behaviors are endorsed by medical organizations a...

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Causes of Hospital Admission for People With Dementia: A Systematic Review and Meta-Analysis

Cited by 113 publications

References 11 publications

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register

Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia

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