• Carole Fogg, Paul Meredith, David Culliford, Jackie Bridges, Claire Spice, and Peter Griffiths.
• Research and Innovation Department, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, PO6 3LY, Cosham, Hampshire, UK; School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, PO1 2FR, Portsmouth, UK; NIHR CLAHRC Wessex, Innovation Centre, Southampton Science Park, 2 Venture Road, SO16 7NP, Chilworth Hampshire, UK. Electronic address: Carole.Fogg@port.ac.uk.
• Int J Nurs Stud. 2019 Aug 1; 96: 1-8.

BackgroundOlder adults admitted to hospital are often cognitively impaired. It is not clear whether the presence of cognitive impairment conveys an additional risk for poor hospital outcomes in this patient population.ObjectivesTo determine whether cognitive impairment in hospitalised older adults is independently associated with poor outcomes.DesignRetrospective cohort study using electronic, routinely collected data from linked clinical and administrative databases.SettingLarge, acute district general hospital in England.Participants21,399 incident emergency admissions of people aged ≥75, screened for cognitive impairment, categorised to 3 groups: (i) cognitive impairment with a diagnosis of dementia, (ii) cognitive impairment with no dementia diagnosis, (iii) no cognitive impairment.MethodsMultivariable logistic regression and Fine and Gray competing risks survival models were employed to explore associations between cognitive impairment and mortality (in-hospital alone, and in-hospital plus up to 30 days after discharge), time to hospital discharge, and hospital readmission within 30 days of discharge. Covariates included age, severity of illness, main diagnosis, comorbidities and nutritional risk.ResultsTwenty-seven percent of patients had cognitive impairment; of these, 61.5% had a diagnosis of dementia and 38.5% did not. Patients with cognitive impairment and no diagnosis of dementia were most likely to die in hospital or be readmitted, they also had the longest hospital stays. Cognitive impairment was independently associated with mortality in hospital (Odds Ratio 1.34 [1.17-1.55] with dementia; Odds Ratio 1.78 [1.52-2.07] without), mortality in hospital or within 30 days of discharge (Odds Ratio 1.66 [1.48-1.86]; Odds Ratio 1.67 [1.46-1.90]); readmission (Odds Ratio 1.21 [1.04-1.40]; Odds Ratio 1.47 [1.25-1.73]), and increased time until discharge (sub-hazard ratio 0.80 [0.76-0.83]; sub-hazard ratio 0.66 [0.63-0.69]).ConclusionsCognitive impairment is associated with an increased risk of adverse outcomes in hospitalised older people with an unscheduled admission, by increasing hospital mortality, extending hospital stays and increasing frequency of readmissions. Future research should focus on understanding the mechanisms contributing to poorer outcomes in this population.Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

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