Hospital patients with dementia and other causes of confusion have worse outcomes, study finds

Professor Emma Reynish
Professor Emma Reynish, Chair in Dementia Studies

Hospital patients with dementia and other causes of confusion have longer stays and worse treatment outcomes than people without the condition, research led by the University of Stirling has found.

The research is the first large population-based study to prove that people with confusion, caused by dementia or delirium, have inferior treatment outcomes, when compared with the rest of the population.

Lead researcher, Professor Emma Reynish, Chair in Dementia Studies at the University of Stirling, said: “People with confusion – or cognitive spectrum disorders – make up over one-third of the population over 65 who are admitted as an emergency to hospital, and half of patients over the age of 85 years.

“People who are admitted to hospital with confusion seem to do badly, and are at an increased risk of dying, increased risk of re-admission, and a hospital stay nearly two weeks longer than those without confusion. It is unclear whether this is as a result of the care that they are given or the disease process itself, or a combination of both.

Treatment

“People with confusion include: those with dementia; those with delirium – a sudden change in someone’s cognitive state; those with delirium in addition to dementia; and people with undiagnosed dementia. Delirium is most common, at 24.6%, followed by known dementia, at 17.3%. Whatever the cause of their confusion, they all appear to do equally badly.

“Concentrating the hospitals’ treatment and care on just one of these groups of patients – i.e. those with dementia or those with delirium – may be detrimental to the rest of the hospital population who are confused.”

The study found patients with ‘cognitive spectrum disorder’ (CSD) – delirium or dementia – stayed in hospital for an average of 25 days on average – more than double the length of stay for those without CST, who remained for 11.8 days.

Patients with CSD were also more likely to have died within a year of admission – with a 40% mortality rate, compared with a 26% rate in the rest of the hospital population.

Outcomes

Professor Reynish added: “There are two main implications that need urgent attention. The hospital care pathway should be re-examined and designed to centre around those with ‘confusion’ or cognitive spectrum disorders, rather than dementia or delirium alone.

“Secondly, there is a need for further research to determine direct causal relationships – i.e. whether the underlying pathological processes of the disease itself, or the care delivered affect these outcomes – as well as predictors of decline and optimal care pathways for this large, vulnerable and complex population.”

The research, carried out in partnership with experts from the University of Dundee and NHS Fife, examined hospital outcomes in more than 10,000 patients aged 65 or older, with an emergency medical admission.

The study was published in the BMC Medicine journal.

Background information

Media enquiries to Lachlan Mackinnon, Communications Manager, on 01786 466 436, or communications@stir.ac.uk

Notes to editors

University of Stirling

The University of Stirling is ranked fifth in Scotland and 40th in the UK for research intensity in the 2014 Research Excellence Framework. Stirling is committed to providing education with a purpose and carrying out research which has a positive impact on communities across the globe – addressing real issues, providing solutions and helping to shape society.

Interdisciplinary in its approach, Stirling’s research informs its teaching curriculum and facilitates opportunities for knowledge exchange and collaboration between staff, students, industry partners and the wider community.

As Stirling celebrates 50 years, it retains a pioneering spirit and a passion for innovation. The University’s scenic central Scotland campus – complete with a loch, castle and golf course – is home to more than 14,000 students and 1500 staff representing around 120 nationalities. This includes an ever-expanding base for postgraduate study.

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