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Appropriate care for older people with cognitive impairment in hospital

More than half of the patients in adult hospitals are over 65 years of age, many of them frail with multiple comorbidities, frequently including some degree of cognitive impairment. The most common “side effect” experienced by older people in hospital is delirium, sometimes accompanying the illness that brought them to hospital (prevalent delirium), but too frequently developing in hospital (incident delirium) due to misadventure, illnesses contracted, and/or treatments and procedures administered.

Delirium is an acute syndrome characterised by altered levels of consciousness, attention and cognitive function. The overall occurrence of delirium, including prevalent and incident delirium, ranges from 29% to 64% on general or geriatric medicine wards, 11% to 68% on surgical wards (highest in orthopaedics), and 26% to 82% in intensive care units (ICUs). However, many studies exclude people with dementia, thereby likely underestimating the true rates.1 These rates are only found when delirium is actively and frequently screened for by trained researchers. In practice, delirium is missed at least 50% of the time.2,3 The reason that poor detection is of such concern is that delirium is a medical emergency that leads to a 50–500% increase in mortality, with greater disability, cognitive impairment and rates of institutionalisation…