Cognitive impairment in a tertiary hospital: Prevalence and carer experience

Mrs Prue McRae1, Ms Elise  Treleaven1, Ms Karen Lee-Steere1, Mrs Margaret Cahill1, Dr Simon  Finnigan1,3, Associate Professor Alison Mudge1,2

1Royal Brisbane And Women’s Hospital, Brisbane, Australia, 2QUT, Brisbane, Australia, 3UQ Centre for Clinical Research, Brisbane, Australia

Introduction: Cognitive impairment (CI) is common in older hospital inpatients, and associated with poorer outcomes. High quality care requires partnership between patients, healthcare professionals and carers. Hospitalisation can be a stressful experience for people with CI and their carers. The aims of this study were to: 1) To identify the prevalence of CI in patients aged 65 and older; 2) Explore the carers’ experience of involvement in hospital care for patients identified with CI.

Methods: This observational study was conducted at Royal Brisbane and Women’s Hospital on March 14 2018. We performed a cross-sectional study of all ward inpatients (excluding intensive care, emergency department and mental health units) aged 65 years or older using the 4As test, a validated measure of cognitive impairment. We defined score ≥1 as CI, with score ≥4 likely to be delirium. For patients identified with CI, we undertook a brief structured survey of carers, in person or by telephone within 3 days of the audit date.

Results: We screened 218 older patients in 21 wards; 90 (41%) screened positive for CI, with 45 of these likely delirium.  Fifty two (58%) carers completed the survey; most were spouse or child, and 41 (79%) identified as a main carer for the participant. Most carers (44/52, 85%) strongly agreed they felt welcome on the ward (44/52, 85%) and confident leaving their family member on the ward, and 35 (67%) definitely agreed that they were listened to by staff. Only 28 (54%) had been asked about change in cognition and only 8 (15%) had received information on delirium prevention.

Conclusion: CI was prevalent across a broad range of acute and subacute wards. Understanding the carers’ experience will inform strategies to enhance their involvement in delirium prevention and management for their family member in partnership with clinical staff.


Prue Mcrae is the Eat Walk Engage Program Manager at the Royal Brisbane and Women’s Hospital

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