The evidence for introducing case-finding for delirium and dementia in older medical inpatients in a New Zealand hospital

Abstract

Objective The aim of this project was to make the case to the managers of a large urban teaching hospital in New Zealand for the introduction of systematic case-finding for pre-existing cognitive impairment/dementia in older hospital inpatients that screen positive for delirium. Method Two hundred consecutive acute admissions aged 75+ in four medical wards were assessed using the 4AT assessment tool for delirium and the Alzheimer Questionnaire (AQ) for pre-existing cognitive impairment/dementia. Length of stay and mortality at 1 year were also collected. Results Over a third of the sample screened positive for delirium and nearly two-thirds of these also screened positive for dementia. The median length of stay was 5 days for delirium without dementia and 7 days for delirium with dementia, compared to 3 days for those who screened negative for both. After adjustment for age, gender and ethnic group, people who screened positive for delirium (with or without dementia) had 50% longer length of stay ( p < 0.05) and at least double the risk of death ( p < 0.05). Conclusion Older hospital inpatients that screen positive for delirium and dementia using 4AT and AQ have longer lengths of stay and higher mortality. Identification may lead to more timely interventions that help to improve health outcomes and reduce hospital costs.

The association of dementia and delirium with health outcomes in a sample of older inpatients in a New Zealand hospital setting

“…All outcomes were worse for people with delirium (with or without dementia) compared to people with dementia only. The first two findings for length of stay and mortality replicated the findings in our previous analysis of a smaller sample in NZ, 16 in which people who screened positive for delirium (with or without dementia) had double the length of stay and a two-fold risk of death at one year. Likewise, our findings replicated those of recent international studies, which also reported that, compared to patients with no cognitive impairment, patients with delirium and delirium superimposed on de-mentia doubled the length of stay and increased the risk of mortality by two to three times.…”

“…Due to the use of routinely collected data, we were also able to include everyone who had a delirium screen, whereas participants who are too unwell to consent to participate may be excluded in prospective studies. Along with other previous studies, 10,14 have shown that we can use routinely collected data to replicate the findings from similar prospective cohort designs, 5,9,[11][12][13]16 which, although not as methodologically rigorous, demonstrates the utility and cost-effectiveness of this study method.…”

“…8,9, There has been very little research around the prevalence and outcomes of delirium and dementia in New Zealand (NZ) hospital settings. In a small consecutive sample (n=200) of NZ hospital inpatients aged 75+, 16 40% of patients screened positive for delirium and/or dementia, half having either delirium or dementia and half having delirium superimposed on pre-existing dementia. After adjustment for age, gender and ethnic group, people who screened positive for delirium (with or without dementia) had double the length of stay and a two-fold risk of death at one year compared to patients who screened negative for both.…”

Long‐term impact of type 2 diabetes onset on dementia incidence rate among New Zealanders with impaired glucose tolerance: A tapered‐matched landmark analysis over 25 years

“…Our study highlights crucial clinical and public health insights, revealing that IGT individuals developing T2D face a heightened 10‐year dementia incidence rate. It underscores the need for healthcare providers to screen for dementia proactively and offer targeted counselling early on, especially within a decade of diabetes diagnosis 40 …”

“…It underscores the need for healthcare providers to screen for dementia proactively and offer targeted counselling early on, especially within a decade of diabetes diagnosis. 40 Preventing T2D onset in IGT individuals could reduce dementia incidence, 29 emphasizing public health's need for targeted dementia screening, especially for high-risk groups. Prioritizing deprived or minority groups, revealed to have higher dementia rates, underscores the importance of lifestyle interventions, such as smoking cessation and physical activity, in dementia prevention.…”