University of Stirling
Understanding the outcomes of people with cognitive impairment and/or dementia admitted to the general hospital
Alzheimer's disease & other dementias
Background: The study is needed because the experiences and outcomes of patients with cognitive impairment and or dementia in the general hospital are poor. In acute hospital admissions dementia is a common co-morbidity but it is poorly recognised and managed. This leads to adverse consequences for the individual in addition to increased health service costs. Plausible interventions to improve this are necessarily complex because they have to address the multiple clinical and social scenarios encountered, but this requires a good understanding of the population with cognitive impairment in the acute general hospital, and their outcomes. The proposed research will enable accurate documentation of these outcomes in routine clinical practice and the available literature and provide a baseline from which to measure improvement. The proposed study sits in phase 0/1 of the MRC Framework for the Development and Evaluation of Complex Interventions, and will provide the baseline for the development of an intervention for evaluation in the future. Study aim: to improve understanding of the outcomes of hospital admission in people with cognitive impairment and/or dementia. The objectives of the study are twofold: a)Review of Outcomes: Review of current literature to obtain an understanding of the quality and type of evidence that exists about the prevalence of cognitive impairment in older people admitted to hospital as emergencies and associations with a spectrum of outcomes assessed or measured in this domain b)Analysis of Outcomes: To analyse unique routine population based healthcare data to examine healthcare and economic outcomes following hospital admission of older people with and without cognitive impairment and dementia Study design and methods Objective a) Database searches identifying peer reviewed quantitative epidemiology measuring prevalence of cognitive impairment and associations with outcomes and qualitative research identifying a range of outcomes will be carried out. Searches will also include grey literature covering relevant reports, evaluations and surveys. Screening for duplication and relevance will followed by full text review and assessment for quality. A narrative review of the quantitative and qualitative data will be compiled in addition to a collaboative analysis of findings where possible. Objective b) Routine hospital data will be obtained via the Health Informatics Centre. Cohort analysis will examine how a range of outcomes vary between those without cognitive impairment, and those with diagnosed dementia and/or delirium. The analysis will measure associations between CI and important health social care outcomes, which will inform the targeting of future interventions and power calculations. The results will be combined with the cost analysis to better understand the additional costs for the outcomes of those with cognitive impairment in the general hospital. Outputs and dissemination: The findings will contribute to our understanding of the outcomes of patients with cognitive impairmentand or dementia in the general hospital and be of interest to academic and NHS audiences. They will be disseminated through a mix of peer-reviewed academic publications and presentations, and a range of tailored outputs targeting lay, policy and professional audiences. The findings will additionally support the development and optimisation of an intervention to improve outcomes for this population in the general hospital.