Methods: The 4AT was performed within 1-day after operation. A 4AT score of 0 means unlikely delirium or severe cognitive impairment (reference group); a score of 1-3 suggests possible chronic cognitive impairment, without excluding possibility of delirium; a score ≥4 suggests delirium with or without chronic cognitive impairment. Logistic regression, adjusted for: age; sex; nutritional status; co-morbidities; polypharmacy and anticholinergic burden, used the 4AT to predict mobility, length of stay (LOS), mortality, and discharge destination, compared to the reference group.
Results: From 537 (392 women, 145 men: 83.7±8.8 yr) consecutive patients, 522 completed the 4AT; 25% had prolonged LOS (>2 wk) and 6.8% died in hospital. Risk of failure to mobilise within 1-day of surgery was increased 2.4-fold with a 4AT score ≥4. Prolonged LOS was increased 2.4- and 3.1-fold respectively with 4AT scores of 1-3 or ≥4. In-patient mortality was increased 3.1-fold with a 4ATscore ≥4; but not with a 4AT score of 1-3. Change of residence on discharge was increased 3.1-fold with a 4AT score ≥4. These associations persisted after excluding patients with dementia.
Conclusions: For older adults with hip fracture the 4AT independently predicts immobility, prolonged LOS, death in hospital, and change in residence on discharge.
- Cognitive function
- health economics