Associations of 4AT with mobility, length of stay and mortality in hospital and discharge destination among patients admitted with hip fractures

Radcliffe Lisk, Keefai Yeong, Peter Enwere, Josie Jenkinson, Jonathan Robin, Melanie Irvin-Sellers, David Fluck, Ahmad Osmani, Rafit Sharmin, Pankaj Sharma, Chris H Fry, Thang S Han*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

8 Citations (Scopus)
43 Downloads (Pure)


Background: The 4AT (Alertness, Abbreviated Mental Test-4, Attention and Acute change or fluctuating course), a tool to screen cognitive impairment and delirium, has recently been recommended by the Scottish Intercollegiate Guidelines Network (SIGN). We examined its ability to predict health outcomes among patients admitted with hip fractures to a single hospital.
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.
Original languageEnglish
Article numberafz161
Number of pages7
JournalAge and Ageing
Early online date8 Dec 2019
Publication statusE-pub ahead of print - 8 Dec 2019


  • Cognitive function
  • geriatrics
  • health economics
  • NHS

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