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Age Ageing. 2018 Sep 1;47(5):679-684. doi: 10.1093/ageing/afx174.

Impaired cognition is associated with adverse outcome in older patients in the Emergency Department; the Acutely Presenting Older Patients (APOP) study.

Author information

1
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
2
Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands.
3
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
4
Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium.
5
Department of Internal Medicine, section of Acute Care, Leiden University Medical Center, Leiden, The Netherlands.
6
Department of Internal Medicine, section acute care, Alrijne Hospital, the Netherlands.
7
Institute for Evidence-based Medicine in Old Age (IEMO), Leiden, The Netherlands.

Abstract

Objective:

to investigate whether cognitive impairment, measured early after Emergency Department (ED) arrival and irrespective of its cause, is independently associated with functional decline or mortality after 3 and 12 months in older ED patients.

Design and setting:

a prospective multi-centre cohort study in all Acutely Presenting Older Patients visiting the Emergency Department (APOP study) of three hospitals in the Netherlands.

Participants:

2,130 patients, ≥70 years.

Measurements:

data on demographics, disease severity and geriatric characteristics were collected during the first hour of the ED visit. Cognition was measured using the 6-Item-Cognitive-Impairment-Test ('6CIT'). Cognitive impairment was defined as 6CIT ≥11, self-reported dementia or the inability to perform the cognition test. The composite adverse outcome after 3 and 12 months was defined as a 1-point decrease in Katz Activities of Daily Living (ADL), new institutionalisation or mortality. Multivariable regression analysis was used to assess whether cognitive impairment independently associates with adverse outcome.

Results:

of 2,130 included patients, 588 (27.6%) had cognitive impairment at baseline and 654 patients (30.7%) suffered from adverse outcome after 3 months. Cognitive impairment associated with increased risk for adverse outcome (adjusted odds ratio (OR) 1.72, 95%CI 1.37-2.17). After 12 months, 787 patients (36.9%) suffered from adverse outcome. Again, cognitive impairment independently associated with increased risk for adverse outcome (adjusted OR 1.89, 95%CI 1.46-2.46). ORs were similar for patients who were discharged home versus hospitalised patients.

Conclusion:

cognitive impairment measured during the early stages of ED visit, irrespective of the cause, is independently associated with adverse outcome after 3 and 12 months in older patients.

PMID:
29177470
DOI:
10.1093/ageing/afx174
[Indexed for MEDLINE]

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