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Dementia in the acute hospital: prospective cohort study of prevalence and mortality

Marie Curie Palliative Care Research Unit, Department of Mental Health Sciences, University College Medical School, London and Barnet Enfield and Haringey Mental Health Trust, St Ann’s Hospital, London

Martin R. Blanchard, MD MRCPsych

Department of Mental Health Sciences, University College Medical School, London and Camden and Islington Mental Health and Social Care Trust, St Pancras Hospital, London

Louise Jones, MBBS

Marie Curie Palliative Care Research Unit, Department of Mental Health Sciences, University College Medical School, London

Adrian Tookman, MBBS FRCP

Marie Curie Palliative Care Research Unit, Department of Mental Health Sciences, University College Medical School and Royal Free Hospital Hampstead NHS Trust, London

Michael King, MD PhD

Department of Mental Health Sciences, University College Medical School, London, UK

Correspondence: Elizabeth L Sampson, Marie Curie Palliative Care Research Unit, Department of Mental Health Sciences, University College Medical School, Hampstead Campus, Rowland Hill Street, London NW3 2PF, UK. Email: e.sampson{at}medsch.ucl.ac.uk

Declaration of interest

None.

Funding

E.L.S. was funded by a Medical Research Council (UK) Special Training Fellowship in Health Services Research. The study sponsor had no influence on the study design, collection, analysis and interpretation of data, the writing of the report or the decision to submit the paper for publication.

Background

Increasing numbers of people will die with dementia, many in the acute hospital. It is often not perceived to be a life-limiting illness.

Aims

To investigate the prevalence of dementia in older people undergoing emergency medical admission and its effect on outcomes.

Method

Longitudinal cohort study of 617 people (aged over 70). The main outcome was mortality risk during admission.

Results

Of the cohort, 42.4% had dementia (only half diagnosed prior to admission). In men aged 70–79, dementia prevalence was 16.4%, rising to 48.8% of those over 90. In women, 29.6% aged 70–79 had dementia, rising to 75.0% aged over 90. Urinary tract infection or pneumonia was the principal cause of admission in 41.3% of the people with dementia. These individuals had markedly higher mortality; 24.0% of those with severe cognitive impairment died during admission (adjusted mortality risk 4.02, 95% CI 2.24–7.36).

Conclusions

The rising prevalence of dementia will have an impact on acute hospitals. Extra resources will be required for intermediate and palliative care and mental health liaison services.

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				E. B. Mukaetova-Ladinska, A. Teodorczuk, and J. M. Cerejeira Dementia in the acute hospital The British Journal of Psychiatry, November 1, 2009; 195(5): 461 - 462. [Full Text] [PDF]

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