Factors associated with cognitive impairment among older Italian inpatients. Gruppo Italiano di Farmacovigilanza nell'Anziano (G.I.F.A.).

ABSTRACT

OBJECTIVE: To examine the association of cognitive impairment with educational, demographic, and nutritional variables in older hospitalized people. DESIGN: Survey of older patients admitted consecutively to a hospital during two 2-month periods in 1993. SETTING: Patients admitted for general medical care at 35 hospitals participating in the GIFA study throughout Italy. PARTICIPANTS: A total of 3628 patients aged 65 or older were studied. MEASUREMENTS The Hodkinson Abbreviated Mental Test (HAMT) was used as a screening method to assess the patients' basic cognitive function. Multiple logistic regression was used to examine the association between cognitive impairment and demographic, educational or nutritional variables. RESULTS: Twenty-nine percent of older inpatients were classified as having cognitive impairment, with similar distribution of HAMT score found in both genders. Educational attainment has a highly significant inverse relationship with cognitive impairment (highest education OR 0.32; 95% CI 0.20-0.52). Moreover, cognitive impairment decreased with increasing body mass index (3rd tertile OR 0.69; 95% CI 0.51-0.93), cholesterol serum level (highest values OR 0.59; 95% CI 0.37-0.93), circulating lymphocytes (highest values OR 0.55; 95% CI 0.45-0.69), and serum albumin (highest values OR 0.60; 95% CI 0.47-0.76), with a gradient of influence for each variable. CONCLUSIONS: Educational attainment affects cognitive function in older inpatients. The strong association between cognitive impairment and nutritional variables suggests that every effort to improve nutritional status is needed in approaching cognitive impairment in older patients.