Dementia among older in-hospital patients with obstructive airway disease: frequency and consequences.

BACKGROUND: Dementia may influence as a co-morbid condition the management of chronic obstructive airway disease. However, the frequency and the consequences of dementia in older people with chronic obstructive airway disease are largely unknown. PATIENTS AND METHODS: The frequency and the severity of dementia in geriatric in-hospital patients and its impact on feasibility of lung function testing and drug treatment provided were determined. RESULTS: Out of a total of 1,424 patients with obstructive airway disease, 433 (30%) suffered from mild and 307 (22%) suffered from moderate to severe dementia. The frequency of any treatment for obstructive airway disease on admission decreased from 58% in subjects without dementia to 51% of those with mild and to 36% of those with moderate to severe dementia (p<0.01). The feasibility of performing lung function testing also decreased with increasing prevalence of dementia from 86% to 66% and 43%, respectively (p<0.001). CONCLUSION: Dementia is a frequent finding in older in-hospital patients with obstructive airway disease. The majority of subjects with dementia were not able to perform lung function testing. Furthermore, the risk of undertreatment for chronic obstructive airway disease increased. Future guidelines for management of obstructive airway disease must also take into account the special needs and skills of older subjects with dementia.

The terminal phase of life as a team-based clinical global judgment: prevalence and associations in an acute geriatric unit.

BACKGROUND: In most elderly people, the final-terminal-phase of life is characterized by permanent dependency and a complete inability to perform activities of daily living. Treatment targets usually switch from rehabilitation to palliation. However, the prevalence of the clinical judgment "last phase of life" and its association with in-hospital death is unknown in geriatric patients. PATIENTS AND METHODS: We retrospectively analyzed GEMIDAS data from two geriatric units. Patients without cancer and an in-hospital stay of at least 1 week were included in our study. Prevalence of the terminal phase of life was clinically assessed according to the proposals made by M. Gillick. This clinical judgment was pronounced by the geriatric team after a stay in the hospital of at least 1 week. The clinical judgment took into account all available assessment parameters, as well as the impact of a geriatric treatment trial. In addition, the association between the clinical judgment and the risk of in-hospital mortality was analyzed. RESULTS: Records from 2,433 (56%) patients in hospital A and from 1,912 (44%) patients in hospital B were analyzed. The frequency of a terminal phase of life was 30% and 9% (p<0.01), respectively. The frequency depended on the manner of admission to the hospital. In both hospitals, mortality was significantly higher in terminal patients (27% and 37%) than in other patients (0-8% and 0-6%). In both hospitals, the risk of in-hospital mortality was significantly associated with the clinical judgment (OR 3.1 and 2.7), heart failure (OR 2.2 and 2.1), and dementia (OR 2.0 and 1.8). Age, residency in a nursing home, and the Barthel Index on admission were all without relevant impact. CONCLUSION: The frequency of the clinical construct "terminal phase of life" varies in geriatric units between 9% and 30%. This clinical construct is significantly associated with increased in-hospital mortality. Therefore, this construct possesses external validity. Further studies are needed in order to assess the significance of such a clinical judgment, the associations with clinical burdens of symptoms, and the supply structure required to cover the needs of patients and their families.