Routine screening in the general hospital: what happens after discharge to those identified as at risk of dementia?

Abstract

Cognitive screening is recommended for older patients with unplanned hospital admission. We determined rates of reassessment/specialist memory referral after routine inclusion of at risk of dementia status in discharge documentation to primary care. Questionnaires were sent to relevant GP practices on consecutive patients aged ≥75 years identified as at risk and discharged 6 months earlier. Among 53 patients (mean age ±SD = 87.3±6.0 years, mean±SD Abbreviated Mental Test Score = 4.4±2.7), 49 (92%) patients had been reviewed since discharge, and 12/43 (28%) without previously known cognitive problem had had a cognitive reassessment. The most common reasons for non-assessment/referral included clinical factors (eg terminal illness/comorbidities) (n=15) and patient/family wishes (n=5) and that confusion was expected in unwell older patients (n=5). Routine cognitive reassessment/specialist referral appears unjustified in patients identified as at risk of dementia during unplanned hospital admission. However, the prognostic value of delirium/confusion in acute illness is under-recognised and could be used to highlight those at risk.

Keywords: at-risk; dementia; hospitalisation; primary care; prognosis.

Fig 1.

Questionnaire sent to GPs. AMTS = Abbreviated Mental Test Score; CMHT = community mental health team; GPCog = GP cognitive screen; MMSE = mini-mental state examination; MOCA = Montreal Cognitive Assessment.

Fig 2.

Flow diagram of questionnaire data. 6CIT = six-item cognitive impairment test; CMHT = community mental health team; GPCog = GP cognitive screen; MCI = mild cognitive impairment; MMSE = mini-mental state examination.