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

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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.


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


A randomized controlled clinical trial.


A public hospital in Indianapolis.


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.


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.


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


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).


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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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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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).

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