Journal of General Internal Medicine

, Volume 27, Issue 5, pp 561–567

Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial

  • Malaz A. Boustani
  • Noll L. Campbell
  • Babar A. Khan
  • Greg Abernathy
  • Mohammed Zawahiri
  • Tiffany Campbell
  • Jason Tricker
  • Siu L. Hui
  • John D. Buckley
  • Anthony J. Perkins
  • Mark O. Farber
  • Christopher M. Callahan
Original Research

DOI: 10.1007/s11606-012-1994-8

Cite this article as:
Boustani, M.A., Campbell, N.L., Khan, B.A. et al. J GEN INTERN MED (2012) 27: 561. doi:10.1007/s11606-012-1994-8

Abstract

Background

Approximately 40% of hospitalized older adults have cognitive impairment (CI) and are more prone to hospital-acquired complications. The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system.

Objective

Evaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI.

Design

A randomized controlled clinical trial.

Setting

A public hospital in Indianapolis.

Population

A total of 998 hospitalized older adults were screened for CI, and 424 patients (225 intervention, 199 control) with CI were enrolled in the trial with a mean age of 74.8, 59% African Americans, and 68% female.

Intervention

A CDSS alerts the physicians of the presence of CI, recommends early referral into a geriatric consult, and suggests discontinuation of the use of Foley catheterization, physical restraints, and anticholinergic drugs.

Measurements

Orders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs.

Results

Using intent-to-treat analyses, there were no differences between the intervention and the control groups in geriatric consult orders (56% vs 49%, P = 0.21); discontinuation orders for Foley catheterization (61.7% vs 64.6%, P = 0.86); physical restraints (4.8% vs 0%, P = 0.86), or anticholinergic drugs (48.9% vs 31.2%, P = 0.11).

Conclusion

A simple screening program for CI followed by a CDSS did not change physician prescribing behaviors or improve the process of care for hospitalized older adults with CI.

KEY WORDS

cognitive impairmentclinical trialdecision supporthospitalized elders

Supplementary material

11606_2012_1994_MOESM1_ESM.doc (53 kb)
ESM 1(DOC 53 kb)

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Malaz A. Boustani
    • 1
    • 2
    • 3
  • Noll L. Campbell
    • 1
    • 2
    • 4
    • 5
  • Babar A. Khan
    • 3
  • Greg Abernathy
    • 2
  • Mohammed Zawahiri
    • 1
    • 2
  • Tiffany Campbell
    • 1
    • 2
  • Jason Tricker
    • 3
  • Siu L. Hui
    • 1
    • 2
    • 3
  • John D. Buckley
    • 1
    • 2
    • 3
  • Anthony J. Perkins
    • 2
  • Mark O. Farber
    • 3
  • Christopher M. Callahan
    • 1
    • 2
    • 3
  1. 1.Indiana University Center for Aging ResearchIndianapolisUSA
  2. 2.Regenstrief Institute, IncIndianapolisUSA
  3. 3.Department of MedicineIndiana University School of MedicineIndianapolisUSA
  4. 4.Department of Pharmacy Practice, College of PharmacyPurdue UniversityWest LafayetteUSA
  5. 5.Department of PharmacyWishard Health ServicesIndianapolisUSA