Cognitive impairment in the elderly medically ill: How often is it missed?

One hundred and sixty‐three patients over 65 years of age admitted to the acute medical wards of a district teaching hospital were studied for prevalence and type of cognitive impairment. Findings from research assessments, where possible using a cognitive rating scale, were compared with detection of impairment by medical and nursing staff involved in patients' clinical management. 30.7% of patients were judged by us to show definite or probable cognitive impairment, a figure substantially higher than that detected by hospital staff. Outcomes in terms of death, duration of admission and discharge location were related to the presence or absence of cognitive impairment and whether impairment was due to delirium, dementia or a mixed syndrome. The low rate of detection of cognitive impairment is discussed, and suggestions made to improve detection in acute elderly medical inpatients.

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