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A Multicomponent Model to Improve Hospital Care of Older Adults with Cognitive Impairment: A Propensity Score–Matched Analysis.

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Title: A Multicomponent Model to Improve Hospital Care of Older Adults with Cognitive Impairment: A Propensity Score–Matched Analysis.
Authors: Sinvani, Liron, Warner‐Cohen, Jessy, Strunk, Andrew, Halbert, Travis, Harisingani, Ruchika, Mulvany, Colm, Qiu, Michael, Kozikowski, Andrzej, Patel, Vidhi, Liberman, Tara, Carney, Maria, Pekmezaris, Renee, Wolf‐Klein, Gisele, Karlin‐Zysman, Corey
Source: Journal of the American Geriatrics Society. Sep2018, Vol. 66 Issue 9, p1700-1707. 8p. 5 Charts.
Subjects: Benzodiazepines, Cognition disorders treatment, Tranquilizing drugs, Hospital medical staff, Antipsychotic agents, Elder care, Hospital care of older people, Bed rest, Health care teams, Length of stay in hospitals, Medical appointments, Paradigms (Social sciences), Quality assurance, Patient participation, Disease management, Discharge planning, Treatment effectiveness, Retrospective studies, Patient readmissions, Hospital mortality, Tertiary care, Old age, Education
Abstract: Objectives: To determine whether a multicomponent intervention improves care in hospitalized older adults with cognitive impairment. Design: One‐year retrospective chart review with propensity score matching on critical demographic and clinical variables was used to compare individauls with cognitive impairmenet on intervention and nonintervention units. Setting: Large tertiary medical center. Participants: All hospitalized individuals age 65 and older with cognitive impairment admitted to medicine who required constant or enhanced observation for behavioral and psychological symptoms. Intervention: Multicomponent intervention (geographic unit cohorting, multidisciplinary approach, patient engagement specialists (PES), staff education) or usual care. Measurements: In‐hospital mortality, length of stay, readmission, management of behavioral disturbances. Results: After propensity score matching, 476 of the 712 intervention visits were pair‐matched with 476 of the 558 usual care visits. Matching was successful in balancing baseline covariates between intervention and usual care units. Individuals admitted to the intervention unit had lower in‐hospital mortality (1.1% vs 2.9%, p=0.05) and shorter stays (5.0 vs 5.8 days, p=0.04). There was no difference in discharge home (p=0.90) or 30‐day readmission rates (p=0.44). Individuals on the intervention unit were less likely than those receivng usual care to have an order for constant (12.0% vs 45.8%, p<0.01) or enhanced (22.1% vs 79.6%, p<0.01) observation, to be taking benzodiazepines (26.3% vs 38.0%, p<0.01), to be taking nothing by mouth (29.6% vs 40.8%, p=0.01), to be on bedrest (17.0% vs 25.8%, p=0.01), to be taking antipsychotics (41.2% vs 54.0%, p<0.01), or to have restraints (3.2% vs 6.9%, p=.01). Conclusion: A multicomponent intervention of geographic cohorting, multidisciplinary approach, PES, and staff education may offer a new paradigm in the management of hospitalized older adults with cognitive impairment. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: A Multicomponent Model to Improve Hospital Care of Older Adults with Cognitive Impairment: A Propensity Score–Matched Analysis.
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  Data: Objectives: To determine whether a multicomponent intervention improves care in hospitalized older adults with cognitive impairment. Design: One‐year retrospective chart review with propensity score matching on critical demographic and clinical variables was used to compare individauls with cognitive impairmenet on intervention and nonintervention units. Setting: Large tertiary medical center. Participants: All hospitalized individuals age 65 and older with cognitive impairment admitted to medicine who required constant or enhanced observation for behavioral and psychological symptoms. Intervention: Multicomponent intervention (geographic unit cohorting, multidisciplinary approach, patient engagement specialists (PES), staff education) or usual care. Measurements: In‐hospital mortality, length of stay, readmission, management of behavioral disturbances. Results: After propensity score matching, 476 of the 712 intervention visits were pair‐matched with 476 of the 558 usual care visits. Matching was successful in balancing baseline covariates between intervention and usual care units. Individuals admitted to the intervention unit had lower in‐hospital mortality (1.1% vs 2.9%, p=0.05) and shorter stays (5.0 vs 5.8 days, p=0.04). There was no difference in discharge home (p=0.90) or 30‐day readmission rates (p=0.44). Individuals on the intervention unit were less likely than those receivng usual care to have an order for constant (12.0% vs 45.8%, p&lt;0.01) or enhanced (22.1% vs 79.6%, p&lt;0.01) observation, to be taking benzodiazepines (26.3% vs 38.0%, p&lt;0.01), to be taking nothing by mouth (29.6% vs 40.8%, p=0.01), to be on bedrest (17.0% vs 25.8%, p=0.01), to be taking antipsychotics (41.2% vs 54.0%, p&lt;0.01), or to have restraints (3.2% vs 6.9%, p=.01). Conclusion: A multicomponent intervention of geographic cohorting, multidisciplinary approach, PES, and staff education may offer a new paradigm in the management of hospitalized older adults with cognitive impairment. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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