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Enhancing care for hospitalized older adults with cognitive impairment: a randomized controlled trial


Boustani, Malaz A., Campbell, Noll L., Khan, Babar A., Abernathy, Greg, Zawahiri, Mohammed, Campbell, Tiffany, Tricker, Jason, Hui, Siu L., Buckley, John D., Perkins, Anthony J., Farber, Mark O., Callahan, Christopher M.


Journal Of General Internal Medicine, Volume: 27, No.: 5, Pages.: 561-567

Year of Publication



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.;

Bibtex Citation

@article{Boustani_2012, doi = {10.1007/s11606-012-1994-8}, url = {}, year = 2012, month = {feb}, publisher = {Springer Science $mathplus$ Business Media}, volume = {27}, number = {5}, pages = {561--567}, author = {Malaz A. Boustani and Noll L. Campbell and Babar A. Khan and Greg Abernathy and Mohammed Zawahiri and Tiffany Campbell and Jason Tricker and Siu L. Hui and John D. Buckley and Anthony J. Perkins and Mark O. Farber and Christopher M. Callahan}, title = {Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial}, journal = {J {GEN} {INTERN} {MED}} }


adult, aged, aged, 80 and over, clinical, cognition disorders, decision, decision support systems clinical, female, geriatric assessment, hospitalization, humans, intention to treat analysis, male, methods, quality of health care, questionnaires, support, system, therapy

Countries of Study


Types of Dementia

Mild Cognitive Impairment (MCI)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Service use or cost reductions (incl. hospital use reduction, care home admission delay)


Hospital Inpatient Care

Type of Interventions

Non-pharmacological Treatment, Workforce oriented interventions

Non-Pharmaceutical Interventions


Workforce Interventions