Introduction Over one-third of older people with unplanned admissions to hospital are frail, but data on the burden of delirium, dementia and other cognitive frailty are lacking. Reliable hospital-wide and specialty-specific prevalence estimates are needed for service-planning including understanding the role of non-geriatricians in caring for this population. Methods ORCHARD includes pseudo-anonymised EPR data for consecutive admissions with a length of stay of >1 day (2017–2019) to four hospitals in Oxfordshire (population = 800,000). Data are collected using a standard cognitive screen comprising dementia history, delirium diagnosis (Confusion Assessment Method-CAM), and 10-point Abbreviated Mental Test-AMTS that is mandated on admission for all patients >70 years. Cognitive frailty was defined as delirium, diagnosed dementia, delirium+dementia or AMTS<8 without delirium/dementia. We analysed the ORCHARD data to determine the prevalence of delirium/cognitive frailty trust-wide and by specialty (n = 29 with >50 admissions). Results Among 51,202 admissions with mean/sd age = 82/7 years and Hospital Frailty Risk Score = 8/6, any cognitive frailty was present in 34.5% (95%CI 34.0–34.9%; n = 17,466) of which delirium accounted for 14.6% (n = 7411), delirium+dementia = 9.4% (n = 4757), dementia = 7.5%, (n = 3784), AMTS<8 = 3% (n = 1514). The prevalence of cognitive frailty in general medicine, general surgery and trauma/orthopaedics, which accounted for 80% of admissions (n = 41,016), was 41% (n = 13,879), 21% (n = 801) and 35% (n = 1304) in each, respectively. The prevalence was 44% in geriatric medicine admissions (n = 133/301), 36% in palliative (n = 128/356), 29% in stroke (n = 135/468), 27% in infectious disease (n = 41/152), 22% in neurosurgery (n = 154/702) and 10–20% in all other specialties except two. Delirium was the most prevalent form of cognitive frailty in 24/29 specialties. Discussion Cognitive frailty is common in older unplanned hospital admissions across a broad range of specialties, with delirium accounting for most cases. Our findings support the need for hospital-wide and specialty-specific training and service development to reflect the needs of these older complex patients and increased emphasis on delirium in policy.

中文翻译：

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2323 > 全院和各专科的谵妄、痴呆和认知测试缺陷患病率 50,000 例计划外入院


引言 超过三分之一的计划外入院老年人身体虚弱，但缺乏关于谵妄、痴呆和其他认知虚弱负担的数据。服务规划需要可靠的全院和特定专业的患病率估计，包括了解非老年病学家在照顾这一人群中的作用。方法 ORCHARD 包括牛津郡四家医院（人口 = 800,000）连续入院的伪匿名 EPR 数据，住院时间为 >1 天 （2017-2019）。使用标准认知筛查收集数据，包括痴呆病史、谵妄诊断（意识模糊评估方法-CAM）和 10 点简化心理测试 AMTS，该测试在所有患者 >70 岁入院时强制要求。认知虚弱定义为谵妄、诊断为痴呆、谵妄+痴呆或 AMTS<8 无谵妄/痴呆。我们分析了 ORCHARD 数据，以确定整个信托基金和专业 （n = 29，>50 入院） 的谵妄/认知衰弱患病率。结果 在 51,202 例平均/SD 年龄 = 82/7 岁且医院虚弱风险评分 = 8/6 的入院患者中，任何认知虚弱都存在于 34.5% （95% CI 34.0–34.9%;n = 17,466），其中谵妄占 14.6% （n = 7411），谵妄 + 痴呆 = 9.4% （n = 4757），痴呆 = 7.5%，（n = 3784），AMTS<8 = 3% （n = 1514）。普通医学、普通外科和创伤/骨科的认知衰弱患病率占入院人数的 80% （n = 41,016），分别为 41% （n = 13,879）、21% （n = 801） 和 35% （n = 1304）。 老年医学入院率为 44% （n = 133/301），姑息治疗为 36% （n = 128/356），中风为 29% （n = 135/468），传染病为 27% （n = 41/152），神经外科为 22% （n = 154/702） 和 10-20% 在除两个外的所有其他专业。谵妄是 24/29 专业中最普遍的认知衰弱形式。讨论 认知衰弱在广泛的专科中，老年计划外住院很常见，其中谵妄占大多数。我们的研究结果支持需要全院和特定专业的培训和服务开发，以反映这些老年复杂患者的需求，并在政策中更加强调谵妄。