Hospital outcomes of older people with cognitive impairment: An integrative review

Abstract

ObjectivesTo 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.MethodsIntegrative 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.ResultsOne 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.ConclusionsOlder 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.

Validation and psychometric evaluation of the Dutch Person-centred care of Older People with cognitive impairment in Acute Care (POPAC)

“…To improve the quality of care for people with dementia in an acute care setting, knowledge of the level of person-centeredness of the care is important. The literature reports a limited number of instruments that measure person-centred care for people with dementia in an acute hospital setting (10,24). Available instruments are aimed at long term care (25) or more generically on person-centred care in the acute hospital setting as well as the lack of a specific focus on the quality of care for people with dementia (26)(27)(28)(29).…”

Implementation of a model of care for hospitalised older persons with cognitive impairment (the Confused Hospitalised Older Persons program) in six New South Wales hospitals

“…More than 30% of patients aged 65 years and over present with cognitive impairment or develop it during their admission . For these patients, there is an increased risk of falls and fall‐related injury, worsening functional decline, increased length of hospital stay, increased chance of medical and surgical complications, increased chance of institutionalisation and increased mortality . The Australian Institute of Health and Welfare report on Dementia Care in Hospitals (2013) noted that 47% of older patients with dementia were not recognised as such.…”

Activity interventions to improve the experience of care in hospital for people living with dementia: a systematic review

“…heart disease, diabetes) [4]. Those admitted to hospital with dementia experience complications and adverse outcomes including longer length of stay, greater mortality and increased risk of institutionalization post-discharge compared to those without dementia [5,6]. While 20% of hospital admissions of Plwd are potentially preventable [7] some unplanned admissions are unavoidable, and it is important that hospital care supports the needs of those affected by dementia.…”