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The association between cognitive impairment and functional outcome in hospitalised older patients: a systematic review and meta-analysis.

Abstract

Background

in hospitalised older adults, cognitive impairments are common and may be associated with functional outcomes. Our aim was to systematically review this association.

Method

we systematically searched MEDLINE, CINAHL, AMED and PsycINFO from inception to April 2016. Non-English language studies were filtered out at search stage. All types of studies were considered for inclusion except reviews, conference abstracts, dissertations and case studies. Population: community-dwelling or institutionalised older adults aged 65 years or more, who are acutely hospitalised and have information on history of dementia and/or cognitive scores on admission. Setting: acute hospital (excluding critical care and subacute or intermediate care). Outcome of interest: change in a measure of physical function or disability between pre-admission or admission, and discharge or post-discharge. This review was registered on PROSPERO (CRD42016035978).

Results

the search returned 5,988 unique articles, of which 34 met inclusion criteria. All studies were observational, with 30 prospective and 4 retrospective from 14 countries, recruiting from general medicine (n = 11), geriatric medicine (n = 11) and mixed (n = 12) wards. Twenty-six studies (54,637 participants) were suitable for the quantitative synthesis. The meta-analysis suggested that cognitive impairment was associated with functional decline in hospitalised older adults (risk ratio (RR): 1.64; 95% confidence interval (CI): 1.45-1.86; P < 0.01). Results were similar in subanalyses focusing on diagnosis of dementia (RR: 1.36; 95% CI: 1.05-1.76; P = 0.02; n= 2,248) or delirium (RR: 1.55; 95% CI: 1.31-1.83; P < 0.01; n= 1,677).

Conclusion

cognitive impairments seem associated with functional decline in hospitalised older people. Causality cannot be inferred, and limitations include low quality of studies and possible confounding.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

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    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

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    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

    ,

    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

    ,

    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

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    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

    ,

    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

    ,

    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

    ,

    Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

    Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, Box 135, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK. Department of Public Health and Primary Care, University of Cambridge, Clinical Gerontology Unit, Box 251, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.

    Source

    Age and ageing 46:4 2017 07 01 pg 559-567

    MeSH

    Age Factors
    Aged
    Aging
    Chi-Square Distribution
    Cognition
    Cognition Disorders
    Dementia
    Female
    Frailty
    Geriatric Assessment
    Hospitalization
    Humans
    Male
    Odds Ratio
    Prognosis
    Recovery of Function
    Risk Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    28119313

    Citation

    Hartley, Peter, et al. "The Association Between Cognitive Impairment and Functional Outcome in Hospitalised Older Patients: a Systematic Review and Meta-analysis." Age and Ageing, vol. 46, no. 4, 2017, pp. 559-567.
    Hartley P, Gibbins N, Saunders A, et al. The association between cognitive impairment and functional outcome in hospitalised older patients: a systematic review and meta-analysis. Age Ageing. 2017;46(4):559-567.
    Hartley, P., Gibbins, N., Saunders, A., Alexander, K., Conroy, E., Dixon, R., ... Romero-Ortuno, R. (2017). The association between cognitive impairment and functional outcome in hospitalised older patients: a systematic review and meta-analysis. Age and Ageing, 46(4), pp. 559-567. doi:10.1093/ageing/afx007.
    Hartley P, et al. The Association Between Cognitive Impairment and Functional Outcome in Hospitalised Older Patients: a Systematic Review and Meta-analysis. Age Ageing. 2017 07 1;46(4):559-567. PubMed PMID: 28119313.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The association between cognitive impairment and functional outcome in hospitalised older patients: a systematic review and meta-analysis. AU - Hartley,Peter, AU - Gibbins,Nathalie, AU - Saunders,Amanda, AU - Alexander,Kerry, AU - Conroy,Eimear, AU - Dixon,Rebecca, AU - Lang,Joseph, AU - Luckett,Jasmine, AU - Luddington,Tim, AU - Romero-Ortuno,Roman, PY - 2016/08/07/received PY - 2017/01/05/accepted PY - 2017/1/26/pubmed PY - 2018/1/30/medline PY - 2017/1/26/entrez KW - cognitive impairments KW - frail older adults KW - functional decline KW - hospital KW - systematic review SP - 559 EP - 567 JF - Age and ageing JO - Age Ageing VL - 46 IS - 4 N2 - Background: in hospitalised older adults, cognitive impairments are common and may be associated with functional outcomes. Our aim was to systematically review this association. Method: we systematically searched MEDLINE, CINAHL, AMED and PsycINFO from inception to April 2016. Non-English language studies were filtered out at search stage. All types of studies were considered for inclusion except reviews, conference abstracts, dissertations and case studies. Population: community-dwelling or institutionalised older adults aged 65 years or more, who are acutely hospitalised and have information on history of dementia and/or cognitive scores on admission. Setting: acute hospital (excluding critical care and subacute or intermediate care). Outcome of interest: change in a measure of physical function or disability between pre-admission or admission, and discharge or post-discharge. This review was registered on PROSPERO (CRD42016035978). Results: the search returned 5,988 unique articles, of which 34 met inclusion criteria. All studies were observational, with 30 prospective and 4 retrospective from 14 countries, recruiting from general medicine (n = 11), geriatric medicine (n = 11) and mixed (n = 12) wards. Twenty-six studies (54,637 participants) were suitable for the quantitative synthesis. The meta-analysis suggested that cognitive impairment was associated with functional decline in hospitalised older adults (risk ratio (RR): 1.64; 95% confidence interval (CI): 1.45-1.86; P < 0.01). Results were similar in subanalyses focusing on diagnosis of dementia (RR: 1.36; 95% CI: 1.05-1.76; P = 0.02; n= 2,248) or delirium (RR: 1.55; 95% CI: 1.31-1.83; P < 0.01; n= 1,677). Conclusion: cognitive impairments seem associated with functional decline in hospitalised older people. Causality cannot be inferred, and limitations include low quality of studies and possible confounding. SN - 1468-2834 UR - https://www.unboundmedicine.com/medline/citation/28119313/The_association_between_cognitive_impairment_and_functional_outcome_in_hospitalised_older_patients:_a_systematic_review_and_meta_analysis_ L2 - https://academic.oup.com/ageing/article-lookup/doi/10.1093/ageing/afx007 DB - PRIME DP - Unbound Medicine ER -