Delirium Among Hospitalized AD Patients: The Long-Term Impact

Delirium Among Hospitalized AD Patients: The Long-Term Impact

Recent studies show that patients with Alzheimer’s Disease (AD) who are hospitalized are at increased risk for further cognitive decline, institutionalization, and death in the year following their hospital stay. These risks are highest among those who develop delirium while being hospitalized. Little attention has been paid to the consequences of delirium on cognitive deterioration among patients with AD. Most studies have focused on short-term cognitive outcomes, but few have addressed whether these changes result in enduring problems in cognitive function. Examining Long-Term Changes Following Delirium In the August 20, 2012 online issue of the Archives of Internal Medicine, a study by senior investigator Sharon K. Inouye, MD, MPH, myself, and other colleagues explored the long-term trajectory of cognitive decline among older adults with AD who experienced delirium while they were hospitalized. The rate of cognitive deterioration was monitored for up to 5 years before and 5 years after hospitalization. Delirium in patients with AD was independently associated with cognitive deterioration for up to 5 years after hospitalization; the rate was roughly twice that of patients with AD who did not develop delirium while hospitalized. Delirium is a Medical Emergency In our analysis, delirium developed in 56% of the study group. Unfortunately, research suggests that delirium is recognized by physicians in fewer than 30% of hospital patients. Our study serves as an alarm to the long-term dangers of delirium on the development and progression of long-term cognitive impairment. Physicians should handle delirium cases among AD patients as they would a true medical emergency. Strategies to Prevent Delirium Efforts are needed to incorporate delirium prevention routinely into standard practices for...

Predicting Preadmission Medication Understanding

In the hospital setting, it is vitally important that patients understand their medication regimen. Patients are often the primary source of information when physicians take a medication history for medication reconciliation. If patients don’t understand their preadmission medication regimen, their risk for errors in inpatient and post-discharge medication orders increases. “Lower health literacy, impaired cognition, and a higher number of medications can affect the accuracy of patient-reported medication regimens.” Few studies have examined how well patients understand their preadmission medication regimen and the factors that affect understanding. Low health literacy, advanced age, and impaired cognitive function all have the potential to adversely affect understanding of medication instructions. To address gaps in research, my colleagues and I conducted a study that was published in the November 2011 Journal of Hospital Medicine in which we examined how certain patient factors affected understanding of preadmission medication regimens. Predictors of Medication Understanding In our analysis, 790 patients from Vanderbilt University Hospital and Brigham & Women’s Hospital were eligible for the investigation. We found that 21% of participants had marginal or inadequate health literacy. Also, the median number of medications that they were taking was eight. The following were each independently associated with less understanding of the purpose, dose, and/or frequency of their preadmission medication regimen: Lower health literacy. Lower cognitive function. Higher number of medications. Furthermore, we found that for each increase by one medication, there was a significant decrease in medication understanding. Patients on six medications were about half as likely to understand their medication regimen as patients on only one medication. For patients on 11 medications, the odds of medication understanding...