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      Implementation of a model of care for hospitalised older persons with cognitive impairment (the Confused Hospitalised Older Persons program) in six New South Wales hospitals

      1 , 1 , 1 , 2 , 2 , 2
      Australasian Journal on Ageing
      Wiley

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          Hospital outcomes of older people with cognitive impairment: An integrative review

          Objectives To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. Methods Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. Results One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all‐cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. Conclusions Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes.
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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. Although not a normal part of ageing, many older people will present to hospital with cognitive impairment (dementia or delirium) along with other complex comorbidities. Older people, and particularly those with dementia, are also at increased risk of developing delirium during their hospital stay. Delirium has serious short and long term consequences, such as increased mortality, falls, accelerated functional and cognitive decline, and earlier entry to residential care. Appropriate delirium care consists of introducing evidence-based prevention strategies for all patients at risk. For patients with delirium, it is crucial that delirium is not missed and that the underlying causes are identified and treated. Screening, assessment and a systematic workup is vital. As well as treating the underlying medical and surgical causes, the involvement of family members and a calm, safe environment are important. Patients with cognitive impairment should receive person-centred, goal-directed care so that their particular risks of harm are identified and minimised, and their care is aligned with their preferences and is medically appropriate for their circumstances. Three de-identified, composite case scenarios illustrate, respectively, the role of medicines in causing delirium, how family members can assist in evaluation, and the importance of the appropriate management of post-operative delirium.
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              Author and article information

              Journal
              Australasian Journal on Ageing
              Australas J Ageing
              Wiley
              1440-6381
              1741-6612
              September 08 2019
              September 2019
              September 08 2019
              September 2019
              : 38
              : S2
              : 98-106
              Affiliations
              [1 ]Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
              [2 ]Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
              Article
              10.1111/ajag.12690
              31496063
              a792191e-00f6-424f-ba84-f20637cb04f7
              © 2019

              http://doi.wiley.com/10.1002/tdm_license_1.1

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