Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: The GIFA Study

BACKGROUND: We tested the hypothesis that cognitive impairment upon admission (CIA) and cognitive decline (CD) during hospitalization are associated with an increased risk for functional decline (FD) in older inpatients. METHODS: The Italian Group of Pharmacoepidemiology in the Elderly (Gruppo Italiano di Farmacoepidemiologia nell'Anziano, GIFA) project was a multicenter survey of 9061 older patients admitted to Italian hospitals between 1991 and 1997. CIA was defined as a Hodkinson Abbreviated Mental Test score <7 on admission. The percentage of participants who developed FD, defined as loss of the ability to perform without help one or more activities of daily living between admission and discharge, was compared in patients who did and did not have CIA, and between those who lost at least one point in Hodkinson Abbreviated Mental Test score (CD) and those who did not. RESULTS: Mean age was 77.4 years, and women represented 52.3% of the sample. CIA was present in 21.0% of the patients. During hospitalization, 176 patients (1.9%) experienced FD (4% of those with CIA vs 1.3% of those without CIA). In multivariate analysis, CIA was an important risk factor for FD (odds ratio 2.4; 95% confidence interval, 1.7-3.5; p <.001), independent of age, gender, comorbidity, polypharmacy, and disability on admission. CD occurred in 3.7% of the sample and was strongly associated with an increased risk for FD (odds ratio 16.0; 95% confidence interval, 10.8-23.6; p <.001). CONCLUSIONS: Elderly patients with CIA have a higher risk for FD. New strategies should be implemented to prevent FD in patients with cognitive impairment, who account for a high percentage of older persons who are admitted to hospitals.     

Verbesserung von grundlegenden Alltagsfunktionen, Mobilität und kognitiver Leistungsfähigkeit durch Behandlung in einer geriatrischen Tagesklinik

OBJECTIVES AND METHODS: Several studies showed the efficacy of inpatient geriatric treatment. Different outcomes were reported for geriatric patients treated in outpatient facilities. To analyze the course of rehabilitation, 312 patients (62.2% female) with a mean age of 77.2 years (SD = 7.4) in a geriatric day hospital were evaluated regarding a) changes of functional deficits and mobility, b) cognitive function and c) depression. Patients were examined with a geriatric assessment including activities of daily living, Tinetti, Timed-up and go, Mini Mental State Examination (MMSE), Clock Completion Test, Handgrip Strength-Test, Money-Counting Test and Geriatric Depression Scale (GDS) at admission and discharge. RESULTS: All examined parameters had changed significantly after treatment. A clear decrease in the portion of patients with disability-related outcomes in the examined parameters (Barthel Index, Tinetti, Timed-up and go, MMSE, GDS) was demonstrated: a) the proportion of patients with a Barthel Index under 75 had decreased by 26.5%, the proportion of patients with an increased risk of falls was reduced by 27%, b) the proportion of patients with a MMSE Score less than 24 was decreased by 14.8% and c) mild effects were achieved in depression. CONCLUSIONS: Day hospital geriatric treatment leads to an improvement of functional deficits, mobility and mental health of patients. The results contrast to other studies in day hospital treatment.     

Correlates of cognitive impairment among patients with heart failure: results of a multicenter survey

PURPOSE: Cognitive impairment is an exceedingly prevalent condition among patients with heart failure, independently associated with disability and mortality. However, the determinants of cognitive dysfunction associated with heart failure are still unclear. We assessed the correlates of cognitive impairment among patients with heart failure enrolled in a multicenter pharmacoepidemiology survey. METHODS: The association with cognition of demographic characteristics, objective tests and measures, medications, and comorbid conditions was assessed in 1511 patients with heart failure who had been admitted to 81 hospitals throughout Italy. Cognitive impairment was defined by a Hodkinson Abbreviated Mental Test score < 7. RESULTS: According to multivariate logistic regression modeling, age (per each decade: OR = 2.01; 95% confidence interval [CI] 1.72-2.35), the comorbidity score (OR 1.11; 95% CI 1.03-1.20), education (OR 0.88; 95% CI 0.84-0.2), low serum albumin (OR 1.78; 95% CI 1.35-2.34), sodium (OR 1.56; 95% CI 1.06-2.29), and potassium levels (OR 1.58; 95% CI 1.09-2.29), hyperglycemia (OR 1.33; 95% CI 1.02-1.73), anemia (OR 1.38; 95% CI 1.09-1.75), and systolic blood pressure levels > or = 130 mm Hg (OR 0.60; 95% CI 0.37-0.97) were independently associated with cognitive impairment, after adjusting for potential confounders. Among participants with abnormal laboratory findings on admission, restoration of normal glucose, potassium, and hemoglobin levels during hospital stay was associated with improved cognitive performance at discharge. CONCLUSIONS: Cognitive impairment among patients with heart failure is associated with several comorbid conditions, some of which are potentially treatable. This highlights the key role of comprehensive approach to the assessment and treatment of patients with heart failure.     

Development and evaluation of the GEMS (gait,eyesight, mental state,sedation) tool as an aid to predict outcome after hospitalization

Aim: Discharge planning can be a lengthy process. Prediction of a patient's rehabilitation potential and likely discharge destination, early on in their admission, could be a useful guide for medics, therapists, patients and their carers. Reliable prediction could be used to improve efficiency of discharge planning. The aim of the present study was to identify factors linked to discharge to a residential or nursing home placement and to develop a tool to guide rehabilitation requirements. Methods: This was a three‐phase prospective observational study with blinded end‐point evaluation in two non‐acute rehabilitation hospitals. The study recruited 1174 patients admitted for rehabilitation, over 65 years of age. Phase 1 evaluated 200 patients to identify factors predisposing to institutional discharge. The GEMS (gait, eyesight, mental state, sedation) tool was formulated and validated on the ward in which it was developed (phase 2a) and on two other wards at the same rehabilitation hospital (phase 2b). In phase 3, the tool was evaluated remotely. Results: Patients discharged to a nursing or residential home placement were significantly more likely to have abnormal vision (P = 0.01, 95% confidence interval [CI] = 0.18–0.81), impaired cognitive function (P = 0.012, 95% CI = 0.19–0.81), gait abnormalities (P = 0.01, 95% CI = 0.18–0.79), and more likely to be taking tranquillizers (sedation) (P = 0.0001, 95% CI = 0.01–0.45). Over the three phases, the GEMS tool had a sensitivity of 61.4–88.1% and a specificity of 28.9–61.0%. Conclusion: A GEMS score of 2 or more is significantly associated with discharge to a residential or nursing home placement. This could be used to aid discharge planning and direct rehabilitation service provision. Geriatr Gerontol Int 2011; 11: 8–15.     

Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study

OBJECTIVES: To investigate the characteristics of patients who regain function during hospitalization and the differences in terms of functional outcomes between patients admitted to geriatric and general medicine units. DESIGN: Multicenter, prospective cohort study. SETTING: Acute care geriatric and medical wards of five Italian hospitals. PARTICIPANTS: One thousand forty‐eight elderly patients hospitalized for acute medical diseases. MEASUREMENTS: Functional status 2 weeks before hospital admission (baseline), at admission, and at discharge, as measured using the Barthel Index (BI). RESULTS: Geriatric patients were older (P<.001) and had lower preadmission functional levels (P<.001) than medical patients. Between baseline and discharge, 43.2% of geriatric and 18.9% of medical patients declined in physical function. In the subpopulation of 464 patients who had declined before hospitalization (between baseline and admission), 59% improved during hospitalization (45% of geriatric and 75% of medical patients), whereas only approximately 1% declined further. High baseline function (odds ratio (OR)=1.03, 95% confidence interval (CI)=1.02–1.04, per point of BI) and greater functional decline before hospitalization (OR 0.95, 95% CI 0.94–0.97, per % point of BI decline) were significant predictors of in‐hospital functional improvement; type of hospital ward and age were not. CONCLUSION: Although geriatric patients have overall worse functional outcomes, in‐hospital functional recovery may be frequent even in geriatric units, particularly in patients with greater preadmission functional loss and high baseline level of function.     

The effect of cranioplasty in cognitive and functional improvement: Experience of post traumatic brain injury inpatient rehabilitation

To investigate the effect of cranioplasty on rehabilitation of post-traumatic brain injury (TBI) patients, 37 patients with TBI were arranged by retrospectively assessment study. Those TBI patients receiving in-hospital rehabilitation in the Department of Rehabilitation in a medical center of South Taiwan from 2010 to 2015 were assigned into two groups: A and B. All patients entered the multidisciplinary holistic in-patient rehabilitation training for about 1 month. Patients in Group A received decompressive craniectomy (DC), patients in Group B received DC and cranioplasty. All assessments were arranged right on admission and before discharge. The functional activity evaluation included muscle power and Barthel index (BI), and cognitive function evaluation, including the Rancho Los Amigo Scale, Mini Mental State Examination (MMSE), Community Mental State Examination (CMSE), and the Luria-Nebraska Neuropsychological Battery-Screening Test Short Form (LNNBS). The results showed that there were synergetic effects of cranioplasty on post-TBI patients with rehabilitation training, especially in the BI score, and cognitive improvement in CMSE and LNNBS.     

Relation between destination on discharge in the elderly patients and comprehensive geriatric assessment at admission in the ward of the Geriatric Department of University Hospital

To determine the factors related to the destination on discharge from the geriatric ward of Nagoya University Hospital, we analyzed the relationship between the scores of comprehensive geriatric assessment at admission and the destination in patients who had dwelled in home. The scores of basic activity of daily living (Barthel index), instrumental activity of daily living (Lowton scale), and cognitive function (Mini-Mental State Examination) were significantly lower in the patients who moved to institutions than those in the patients who returned home. The proportion of disabilities in all items, except eating, in the Barthel index, and all items but washing in the Lowton scale were significantly higher in patients who moved to institutions than in patients who returned home. Space orientation, calculation, and drawing in the Mini-Mental State Examination were related to the destination. In items for social life communication and group behavior were related to the destination. In multiple logistic regression models, it was suggested that activity of daily living, specifically independence of excretion, and ability in communication were significantly related to the destination on discharge.     

Sooner and healthier: a randomised controlled trial and interview study of an early discharge rehabilitation service for older people

BACKGROUND: Hospitals are under pressure from admissions of increasing numbers of older people. Older people may suffer unnecessary activity limitation after acute illnesses through lack of appropriate rehabilitation. OBJECTIVE: To evaluate an early discharge and rehabilitation service for older people. DESIGN: A randomised controlled trial comparing an early discharge and rehabilitation with standard hospital aftercare. Outcome measures assessed at 3 and 12 months were the Barthel Index, Nottingham Extended Activities of Daily Living and EuroQol (for patients) the General Health Questionnaire (for patients and carers). Use of services over 12 months was recorded. An interview study of patients and staff was conducted. SETTING AND INTERVENTION: The early discharge and rehabilitation service offered a home-based rehabilitation and care programme for up to 4 weeks. PARTICIPANTS: 370 hospitalised older medical and surgical patients were included in the randomised controlled trial. Twenty patients and 11 staff were interviewed. RESULTS: Subjects in the early discharge rehabilitation service group used fewer days in hospital at 3 months (mean difference 9, median difference 4 days, 95% CI of median difference 2-8). At 3 months the early discharge and rehabilitation service patients had better Barthel scores (mean difference 1.2, 95% CI 0.4-1.9), Nottingham Extended Activities of Daily Living kitchen scores (mean difference 1.2, 95% CI 0.2-2.3), Nottingham Extended Activities of Daily Living domestic scores (mean difference 1.1, 95% CI 0.2-2.0) and General Health Questionnaire scores (mean difference 2.4, 95% CI 0.7-4.1). Significant Nottingham Extended Activities of Daily Living domestic and General Health Questionnaire benefits remained at 12 months. The early discharge and rehabilitation service carers had better General Health Questionnaire scores at 3 months (mean difference 2.0, 95% CI 0.1-3.8). The interviews suggested that the early discharge and rehabilitation service was patient-centred, set clear goals, worked as a team, and considered physical, psychological, social and environmental issues. It was found to be highly satisfactory. CONCLUSIONS: Some older people can be discharged from hospital sooner, with better health outcomes using a well-staffed and organised patient-centred early discharge service providing rehabilitation.     

Comprehensive geriatric assessment and home-based rehabilitation for elderly people with a history of recurrent non-elective hospital admissions

OBJECTIVE: To determine whether a co-ordinated programme of geriatric assessment and multidisciplinary home-based rehabilitation reduces disability and prevents non-elective hospital readmission in high-risk elderly patients. DESIGN: Nested case-control study comparing usual post-discharge care versus usual care plus a comprehensive geriatric assessment and home-based rehabilitation service, comprising nursing, occupational therapy and physiotherapy with geriatric medical review. Patients were >or=65 years with >or=2 non-elective hospital admissions within the previous 12 months. Disability was assessed using the 100-point Barthel index and Nottingham extended activities of daily living (EADL) score. Non-elective hospital admissions were recorded over 1-year follow-up. RESULTS: We studied 84 patients; 56 receiving the new service were matched to 28 controls. Intervention subjects received a median of 19 h [interquartile range (IQR) (7,35)] rehabilitation over 19 [IQR (6,42)] domiciliary visits. At 3 months, there was improvement in median Barthel and Nottingham EADL scores in the intervention group of 3 and 2 points, respectively, compared with reductions in controls of 3 and 6 points (both P<0.001, changes in intervention group versus controls); similar differences persisted in survivors at 12 months. There was a non-significant trend for reduction in the proportion of patients with further non-elective hospital admission in the intervention group (36/56, 64%) compared with controls (21/28, 75%; OR 0.70, 95% CI 0.34, 1.46). CONCLUSIONS: A co-ordinated programme of geriatric assessment and multidisciplinary home-based rehabilitation reduced disability in elderly patients at high risk for non-elective hospital admission. Further research is required to determine whether this approach can reduce the need for hospital admission.     

Dementia as a cofactor for geriatric rehabilitation-outcome in patients with osteosynthesis of the proximal femur: a retrospective, matched-pair analysis of 250 patients

A raising number of patients with osteosynthesis of the proximal femur and additional dementia will be seen in hospitals in the future due to demographic changes. There is an ongoing discussion, if and to what extent cognitive abilities do influence functional outcome in geriatric rehabilitation. We therefore compared 250 patients with osteosynthesis of the proximal femur of whom one half had additional dementia, by a matched-pair analysis for the improvement of mobility assessed by the mobility items of the Barthel Index and the Tinetti mobility index. Dementia was an important cofactor for the success of geriatric rehabilitation. Patients with additional dementia reached lower mobility scores at discharge. Also, patients with dementia had significantly more in-hospital falls. Furthermore, the study revealed that demented patients received less individual and group therapy per hospital day. The study underlines the need for specialized wards treating demented patients with additional illnesses.     

Influence of cognition on personal activities of daily living (P-ADL) in the acute phase: the Gothenburg Cognitive Stroke Study in Elderly

This study examines how prestroke dementia and cognitive dysfunction after stroke influence the personal activities of daily living (P-ADL) in elderly patients in the acute phase after stroke. Elderly stroke patients (n=60) referred to geriatric rehabilitation were included. Assessments were carried out at admission and evaluated at discharge from the geriatric ward. The median age of the group was 77 years. Astrand's questionnaire was used to interview a close relative about the patient's prestroke cognitive status. P-ADL was assessed with the Barthel Index (BI). The Mini Mental State Examination (MMSE) and a neuropsychological test battery were used to measure cognitive functions. Analyses were made using non-parametrical methods. In the acute phase after stroke, neither the presence of prestroke dementia nor the cognitive status after stroke onset among these elderly patients influenced P-ADL at admission or at discharge. Prestroke dementia and cognitive dysfunction's were found to be common after stroke onset, however this did not have any impact on dependence in P-ADL in these elderly patients at admission or at discharge.     

Geriatrie in Bayern-Datenbank (GiB-DAT)

OBJECTIVE: Presentation and comparison of basic data from geriatric rehabilitation in Bavaria with analysis of statistical influences on characteristic values like length of stay and Barthel Index. Are differences between participating clinics due to patient characteristics? SETTING: There were a total of 21 656 data records of the Geriatrics in Bavaria- Database (GiB-DAT) collected by 35 clinics within 1 year. RESULTS (PERCENTAGE OR MEAN): 70.6% female patients, age 80.0 years, 95.9% enrollment from acute care hospitals, length of stay in previous hospitals 24.3 days, length of stay in geriatric rehabilitation 24.6 days. DIAGNOSIS: 41.7% orthopedics, 24.9% neurological, 33.4% others. Barthel Index on admission 44.1 points, on discharge 65.8 points (difference 21.8 points). We found a large variance of all items between participating clinics. Variance for Barthel Index and length of stay is partly cleared up by regression analysis (multinomial logistic) and is mostly due to patient characteristics. CONCLUSIONS: Basic data of Bavarian geriatric rehabilitation clinics is matching with nationwide reference statistics. Differences exist for the lower rate of stroke and direct enrollment of outpatients. A simple ranking of outcome parameters (e. g. Barthel Index) does not make sense due to multiple influencing factors.     

Association of geriatric conditions and cardiovascular diseases with disability in older adults with diabetes: Findings from a nationally representative survey

Aim: To examine how diabetes in combination with cardiovascular diseases (hypertension, heart disease and stroke) and geriatric conditions (cognitive impairment and depressive symptoms) affects the odds of disability in older adults. Methods: We analyzed data from a nationally representative sample of people aged 65 years and over (n = 2727) participating in the 2005 National Health Interview Survey in Taiwan. A total of 473 participants had a history of self‐reported physician diagnosed diabetes. Disability was defined as reporting limitations in one or more tasks of activities of daily living (ADL), instrumental activities of daily living (IADL) or general physical activities (GPA). The Mini‐Mental State Examination was used to assess cognitive function. The Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. Results: After adjustment for other factors, cardiovascular diseases and geriatric conditions independently contributed to the excess odds of disability among participants with diabetes. Participants who had diabetes combined with cardiovascular diseases and geriatric conditions had odds ratios for ADL, IADL and GPA disability of 18.02 (95% CI 5.13–63.34), 7.95 (95% CI 4.07–15.50) and 5.89 (95% CI 3.19–10.90), respectively. Conclusion: Our results highlight the high prevalence of co‐occurrence of cardiovascular diseases with geriatric conditions in people with diabetes. Furthermore, the combined presence of these diseases and conditions is strongly associated with an excess odds of disability. These findings highlight the critical importance of preventing cardiovascular disease morbidity, and improving depressed mood and cognitive function in order to reduce disability risk in older adults with diabetes. Geriatr Gerontol Int 2013; 13: 563–570.     

Postacute care for older people in community hospitals: a multicenter randomized, controlled trial

OBJECTIVES: To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care.
DESIGN: Randomized, controlled trial.
SETTING: Seven community hospitals and five general hospitals in the midlands and north of England.
PARTICIPANTS: Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness.
INTERVENTION: Multidisciplinary team care for older people in community hospitals.
MEASUREMENTS: The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6-month residence status, and satisfaction with services.
RESULTS: Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26–6.28; P =.03). The results for the secondary outcome measures were similar for the two groups.
CONCLUSION: Postacute community hospital rehabilitation care for older people is associated with greater independence.     

Subcortical vascular lesions predict functional recovery after rehabilitation in patients with L-dopa refractory parkinsonism

OBJECTIVES: To identify predictors of functional recovery after an intensive rehabilitation training in patients with gait disturbances and refractory parkinsonism. DESIGN: Observational study. SETTING: A hospital geriatric rehabilitation department ("Ancelle della Carità" hospital of Cremona). PARTICIPANTS: Thirty-eight subjects (mean age+/-standard deviation of 78.9+/-6.5; 66% women) with gait disturbances and L-dopa refractory parkinsonism consecutively admitted to a rehabilitation unit within 6 months were recruited. Exclusion criteria were obvious musculoskeletal disorders (severe leg arthritis, hemiparesis, recent stroke), recent surgery, delirium, physical impairment from other identifiable causes, and missing computed tomography (CT) scan. All subjects received an intensive standardized rehabilitative program including conventional physical therapy and specific gait training. MEASUREMENTS: The outcome measure of the rehabilitation training was the gain between admission and discharge on the Unified Parkinson Disease Rating Scale (delta-UPDRS). The following potential predictors were assessed using comprehensive geriatric assessment: physical health (Charlson Comorbidity Index, number of drugs), cognitive performance (Mini-Mental State Examination (MMSE)), functional status (Tinetti scale), depressive symptoms (Geriatric Depression Scale), nutritional status (serum albumin and body mass index), and subcortical cerebrovascular load (four classes of increasing severity based on diffuse leukoariosis, patchy lesions of the white matter, and lacunas on CT scan). Multivariate logistic regression with fixed adjustment for age, cognitive performance, and UPDRS on admission and stepwise selection of variables were used to identify independent predictors. RESULTS: Patients were divided into two groups of equal size based on the delta-UPDRS (high and low functional recovery: delta-UPDRS >8 and 相似文献   

Three-month follow up of patients discharged from a geriatric day hospital

OBJECTIVE: To determine if mobility and functional status of patients attending a geriatric day hospital are maintained three months after discharge. DESIGN: Prospective, before-after, quasi-experimental design. PARTICIPANTS: Community-dwelling elderly referred for comprehensive geriatric assessment and multidisciplinary management. METHODS: All patients who attended a geriatric day hospital for at least 5 visits and discharged between 1 August, 1999 and 1 March, 2000 were eligible (n = 41). Measurements were performed at admission, discharge and three months post-discharge. Data were analyzed using one way repeated measures ANOVA for parametric data and the Friedman-Chi square test for non-parametric data. OUTCOME MEASURES: Barthel Index, Timed Up and Go Test, Berg Balance Scale, Mini-Mental Status Examination, Geriatric Depression Scale. RESULTS: From admission to discharge, significant improvements were seen in Timed Up and Go Test, Berg Balance Scale, and Geriatric Depression Scale (all P相似文献   

Older hospitalised patients at risk of malnutrition: correlation with quality of life, aid from the social welfare system and length of stay?

BACKGROUND: malnutrition is regarded as a major risk factor for complications and delayed recovery in hospitalised elderly patients. OBJECTIVE: to examine the prevalence of malnutrition in hospitalised elderly patients and evaluate simple clinical screening criteria. To investigate whether malnutrition was related to lack of care from the health care or social welfare system, quality of life and hospital length of stay (LOS). SETTING: non-acute geriatric hospital. SUBJECTS: 294 elderly patients admitted for rehabilitation after acute hospital care; 244 patients were available for assessment. METHODS: questionnaire interview about nutrition, social network and quality of life. Anthropometric and biochemical measurements, assessment of physical and cognitive function, recording of LOS, discharge destination and diagnosis. RESULTS: 126 patients (51.6%) were at risk of malnutrition using the criteria of body mass index<22 kg/m2 and/or weight loss>or=5%/6 months. Poor quality of life in women (P<0.04) and loss of the health of a spouse (P<0.02) correlated with weight loss. No differences were found in patients at risk regarding LOS, discharge destination, or aid from the social welfare system. CONCLUSIONS: this study confirms a high prevalence of malnutrition risk in hospitalised elderly patients. The health care and social welfare system appeared to be unaware of the problem. Poor quality of life in females and loss of the health of a spouse were related to malnutrition risk. The screening variables that were used appeared not to predict hospital length of stay or discharge destination.     

Delirium in elderly general medical inpatients: a prospective study

Background: More than 49% of all US hospital days are spent caring for patients with delirium. There are few Australian data on this important condition. The aim of the study was to determine the prevalence and incidence of delirium in older medical inpatients in a metropolitan teaching hospital, the incidence of known risk factors and current practice in identifying and managing patients at risk of this condition. Methods: Patients aged 65 years or more, and admitted to a general medical unit, were eligible for study inclusion. Participants were screened with an Abbreviated Mental Test Score (AMTS) and chart review. Confusion Assessment Method was used to diagnose delirium if confusion was documented or AMTS <8. Barthel Index (BI), demographics, delirium risk factors and management were recorded. Results: Prevalent delirium was diagnosed in 19 of 104 (18%) and incident delirium in 2 of 85 (2%) participants. Pre‐existing cognitive impairment and admission AMTS <8 were strongly associated with prevalent delirium (P‐values <0.01). Age >80 years, Barthel Index ≤50, use of high‐risk medications and electrolyte disturbance were also associated with prevalent delirium. Prevalent delirium was not recognized by the treating unit in 4 of 19 cases (21%). Five of 104 (4.8%) of participants had a formal cognitive assessment on admission. One of 19 patients (5.3%) with prevalent delirium had an orientation device in their room. Conclusion: Pre‐existing cognitive impairment and admission AMTS are strong predictors of delirium. Despite this, formal cognitive assessment is not routinely carried out in elderly medical patients. Recognition of delirium may be improved by routine cognitive assessment in elderly medical patients.