Adverse Events in Older Hospitalized Patients With Cognitive Impairment

Area of Science:

• Geriatric Medicine
• Patient Safety
• Healthcare Quality

Background:

• Cognitive impairment is increasingly prevalent in hospitalized older adults.
• Cognitive impairment may heighten susceptibility to adverse events (AEs).
• Understanding AE prevalence and characteristics in this population is crucial for improving care.

Purpose of the Study:

• To determine the prevalence of AEs, potentially preventable AEs, and deaths in hospitalized older patients with and without cognitive impairment.
• To analyze the nature, causes, and prevention strategies for AEs in these patient groups.

Main Methods:

• Retrospective analysis of 1959 records from a nationwide study of hospitalized older deceased patients.
• Patients were categorized based on International Classification of Diseases, 10th Revision codes for cognitive impairment (delirium, dementia, etc.).
• Records were reviewed in two stages to assess AEs, their preventability, nature, causes, and recommended prevention strategies.

Main Results:

• 21.8% of patients had cognitive impairment; over 90% had a Charlson comorbidity index ≥5.
• AE prevalence was 13.1% (no impairment) vs. 17.0% (cognitive impairment), not statistically significant (P=.071).
• Cognitively impaired patients, particularly those with delirium, experienced AEs more often related to clinical management (nursing care) and organizational causes.

Conclusions:

• While overall AE prevalence did not differ significantly, the types and causes of AEs varied between cognitively impaired and unimpaired patients.
• Organizational and nursing-related factors were more common causes of AEs in cognitively impaired individuals.
• Further research is needed to explore the interplay of frailty, multimorbidity, cognitive impairment, and patient safety.