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Alzheimer's, Dementia & Mental Health
Senior Citizen's Mental Decline May Go Undetected
When Hospitalized for Acute Illness
Ability to make
decisions about treatment may be impacted
 October
29, 2006 - Many patients over the age of 65 who are hospitalized with an
acute illness experience a subtle change in their cognitive ability that
often goes undiagnosed, untreated and underreported. As a result, a
patient's ability to make decisions about his or her medical treatment
may be negatively impacted.
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These findings by Sharon Inouye, M.D., M.P.H.,
director of the Aging Brain Center at Hebrew SeniorLife and Professor of
Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center,
Harvard Medical School, identified symptoms, such as disorientation,
forgetfulness and an inability to follow directions, that may go
undetected except by those individuals – such as family members – who
know the patient well enough to notice the changes.
A report of Dr. Inouye's findings, "Recoverable
Cognitive Dysfunction at Hospital Admission in Older Persons," will
appear in the December issue of the Journal of General Internal Medicine
(JGIM).
"Acute illness can represent a life-altering event
for an older person, yet the impact of acute illness on cognitive
functioning has not been systematically examined," Dr. Inouye said.
"Understanding a patient's cognitive functioning is also necessary for
developing effective and appropriate discharge planning."
According to Dr. Inouye's paper, no previous
studies exist that establish just how much change in cognitive function
regularly occurs in older patients or how it impacts their care. The
subtle cognitive decline that she examined is referred to as recoverable
cognitive dysfunction (RCD) and is determined by the results of a
questionnaire called the
Mini-Mental State Examination (MMSE), a brief,
standardized method used to assess cognitive status. "MMSE assesses
orientation, attention, immediate and short-term recall, language, and
the ability to follow simple verbal and written commands," Dr. Inouye
said. "Furthermore, it provides a total score that places the individual
on a scale of cognitive function."
Dr. Inouye's study revealed very high rates of RCD
in the patients they surveyed (39%), as well as identified predictors
for incidence of the condition. Predictors included higher educational
level, high level of functional impairment at admission, and high
severity of illness.
"We propose that all older adults should be
considered at risk and screened for RCD when hospitalized with an acute
illness," she said. "In addition, interventions need to be developed and
put in place to prevent or treat the condition."
Editor's Notes:
This study was supported in part by grants from the
National Institute on Aging. The Aging Brain Center is part of Hebrew
SeniorLife's Institute for Aging Research, the country's largest
multidisciplinary geriatric research facility in an applied setting.
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