Cognitively impaired older adults: From hospital to home

Although it's known that cognitive impairment in older adults can adversely affect outcomes of care during and after hospitalization, it often goes unrecognized or is poorly managed. Few clinicians understand these patients' needs or those of their caregivers (a spouse, partner, friend, or family member). For these reasons, we conducted an exploratory study, the primary purposes of which were the following: to determine the rates of cognitive impairment among older adults hospitalized for acute medical or surgical events to identify the needs of these older adults and caregivers throughout an episode of acute illness to examine patients' and caregivers' needs at specific times, during and immediately after hospitalization Older adults hospitalized for a common medical condition, or surgical condition were screened for the presence of cognitive impairment on specified days at three hospitals in Philadelphia for four months. Of 145 who completed the screening, 65% (n = 94) had no evidence of cognitive impairment and 35% (n = 51) had evidence of cognitive impairment; in 65 % (n = 3 3) of the latter group, cognitive impairment was identified only by using the screening instruments. Five cognitively impaired patients and their caregivers were identified as a convenience sub-sample; patients and their caregivers were interviewed together (four times, for a total of 20 patient-caregiver interviews); each caregiver was also interviewed alone (one time for a total of five caregiver interviews). The interviews were transcribed. Analysis of transcriptions revealed that patients and caregivers had unmet, needs in the following categories: managing and negotiating care, managing illness, and psychosocial coping. Findings from this study reinforce the critical importance of individualized interventions targeting the hospitalization and immediate-post-discharge period (two to six weeks).