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

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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.

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ACKNOWLEDGMENTS

Manuscript design, methods, subject recruitment, data collections, analysis, and preparation were sponsored by grant K23-AG026770-01 and grant no. R01AG034205-01A1 from the National Institute on Aging.

Conflict of Interest

Dr. Boustani has work supported by grants from the NIA and AHRQ. He is also a member of the Pfizer speakers’ bureau.

Dr. Buckley has provided expert testimony for local law firms. Mr. Perkins owns stock in several pharmaceutical firms. If further information is needed, please notify our corresponding author.

Author Contributions

All authors had a role in the study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, and preparation of the manuscript.

Funding Source

Dr. Boustani is supported by the NIA Paul B. Beeson K23 Career Development Award no. 1-K23-AG026770-01 and NIA award R01AG034205-01A1.

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Authors and Affiliations

  1. Indiana University Center for Aging Research, Indianapolis, IN, USA

    Malaz A. Boustani MD, MPH, Noll L. Campbell PharmD, Mohammed Zawahiri MD, Tiffany Campbell BS, Siu L. Hui PhD, John D. Buckley MD & Christopher M. Callahan MD

  2. Regenstrief Institute, Inc, 410 West 10th Street, Suite 2000, Indianapolis, IN, 46202, USA

    Malaz A. Boustani MD, MPH, Noll L. Campbell PharmD, Greg Abernathy MD, Mohammed Zawahiri MD, Tiffany Campbell BS, Siu L. Hui PhD, John D. Buckley MD, Anthony J. Perkins MS & Christopher M. Callahan MD

  3. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Malaz A. Boustani MD, MPH, Babar A. Khan MD, Jason Tricker NP, Siu L. Hui PhD, John D. Buckley MD, Mark O. Farber MD & Christopher M. Callahan MD

  4. Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA

    Noll L. Campbell PharmD

  5. Department of Pharmacy, Wishard Health Services, Indianapolis, IN, USA

    Noll L. Campbell PharmD

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  1. Malaz A. Boustani MD, MPH
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  2. Noll L. Campbell PharmD
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Corresponding author

Correspondence to Malaz A. Boustani MD, MPH.

Additional information

Author Contributions: All authors had a role in the study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, and preparation of the manuscript.

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Boustani, M.A., Campbell, N.L., Khan, B.A. et al. Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial. J GEN INTERN MED 27, 561–567 (2012). https://doi.org/10.1007/s11606-012-1994-8

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  • DOI: https://doi.org/10.1007/s11606-012-1994-8

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