Objectives
To determine the prevalence of dementia and the proportion of undiagnosed dementia
in elderly patients admitted to postacute care, and to identify patients' characteristics
associated with undiagnosed dementia.
Design
Cross-sectional study.
Setting
Academic postacute rehabilitation facility in Lausanne, Switzerland.
Participants
Patients (N=1764) aged 70 years and older.
Measurements
Data on socio-demographic, medical, functional, and affective status were collected
upon admission. Data on cognitive performance (Mini-Mental State Exam [MMSE]), and
cognition-related discharge diagnoses were abstracted through a structured review
of discharge summaries.
Results
Overall, 24.1% (425/1764) patients had a diagnosis of dementia, most frequently secondary
to Alzheimer's disease (260/425, 61.2%). Among dementia cases, 70.8% (301/425) were
newly diagnosed during postacute stay. This proportion was lower among patients referred
from internal medicine than from orthopedic/surgery services (65.8% versus 74.8%,
P=.042). Compared to patients with already diagnosed dementia, those newly diagnosed
were older, lived alone more frequently, and had better functional status and MMSE
score at admission (all P < .05). In multivariate analysis, previously undetected dementia remained associated
with older age (OR=2.4 for age 85 years and older, 95% CI 1.5–4.0, P=.001) and normal MMSE at admission (OR=5.9, 95% CI 2.7–12.7, P < .001).
Conclusion
Dementia was present in almost a fourth of elderly patients referred to postacute
care, but was diagnosed in less than a third before admission. Oldest old patients
appear especially at risk for underrecognition. These results emphasize the high diagnostic
yield of systematic cognitive assessment in the postacute care setting to improve
these patients' management and quality of life.
Keywords
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Article info
Publication history
Published online: March 25, 2010
Footnotes
The authors have no conflicts of interest.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
