Cognitive Status of Older Adults on Admission to a Skilled Nursing Facility According to a Hospital Discharge Diagnosis of Dementia.
Brian Downer, Kali S Thomas, Vincent Mor and 2 others
PMID 28623153WHAT IT FOUND
A hospital discharge dementia diagnosis did not always match cognitive testing at skilled nursing facility admission.
Among beneficiaries with that diagnosis, 17.9% were cognitively intact and 25.8% were mildly impaired.
Key findings
01In the final analytic sample of 1,885,015 newly admitted Medicare beneficiaries, 252,970 had a hospital discharge diagnosis of dementia.
02Among beneficiaries with a hospital dementia diagnosis, 17.9% were cognitively intact, 25.8% were mildly impaired, 45% were moderately impaired, and 11.3% were severely impaired at skilled nursing facility admission.
03The median cognitive status for beneficiaries with a hospital dementia diagnosis was moderately impaired, while it was cognitively intact for those without a dementia diagnosis.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis used Medicare claims and MDS data, not medical chart reviews, so it could not determine why a hospital dementia diagnosis and skilled nursing facility cognitive status differed. The MDS cognitive screen does not identify mild cognitive impairment, so some beneficiaries with a hospital dementia diagnosis may have had a milder condition. The Brief Interview for Mental Status does not assess executive function or language, so it may miss dementia patterns that are not memory or orientation problems. Beneficiaries with stroke, delirium, or coma were excluded, so the results do not describe those common hospital-to-skilled-nursing-facility populations. This was a descriptive analysis of one admission point, not a test of whether a dementia diagnosis caused any outcome or whether correcting it changed care.
Declared interests
One author reported being chair of the Independent Advisory Committee on Quality for HCRManorCare and chair of the Scientific Advisory Committee for naviHealth. No other disclosures were reported.
The easy way to misread this
Do not conclude that a hospital dementia diagnosis is wrong for an individual patient. This analysis compared group-level administrative records with facility cognitive screening and did not review charts to identify why the records differed.