Care complexity in hospitalized elderly according to cognitive performance

to investigate possible differences in care complexity, functional performance and biopsychosocial and health system aspects among hospitalized elderly with or without cognitive decline.

Method:

quantitative, cross-sectional and analytical study in which was used the INTERMED method and cognitive and functional screening scales. We investigated 384 elderly patients admitted to a medical and surgical clinic of a University Hospital located in São Paulo/SP.

Results:

cognitive decline was present in 40.1% of the sample, most of them were longer-lived elderly individuals with less schooling and income, more dependent in activities of daily living and had greater vulnerability in different domains of INTERMED. After adjustments, the elderly with cognitive decline presented greater vulnerability in the psychological domain.

Conclusion:

the relationship between cognitive decline and psychological vulnerability highlights the need to adopt long-term care based on involvement of the family, health team and different services, thereby maximizing the quality of care.

Descriptors:
Elderly; Cognitive Decline; Behavioral Symptoms; Comprehensive Health Care; Hospital

Sample characteristics (N=382)	No decline (n=229) n (%)	With decline (n=153 )n (%)	p value
Sex
Male	116 (65.91)	60 (34.09)	0.028
Female	113 (54.85)	93 (45.15)
Age
60 \|- 69	105 (66.46)	53 (33.54)	0.000
70 \|- 80	91 (64.54)	50 (35.46)
80 \|- +	33 (39.76)	50 (60.24)
Schooling (years)
No schooling	24 (32.88)	49 (67.12)	0.000
<8 years	180 (65.93)	93 (34.07)
>8 years	25 (69.44)	11 (30.56)
Self-reported race
White	159 (62.6)	95 (37.4)	0.245
Mixed race	29 (49.15)	30 (50.85)
Black	36 (57.14)	27 (42.84)
Asian	5 (83.33)	1 (16.67)
Marital status
Married	121 (67.98)	57 (32.02)	0.007
Widowed	68 (52.31)	62 (47.69)
Single or separated	40 (54.05)	34 (45.95)
Income (number of minimum wages)
No income	59 (47.97)	64 (52.03)	0.004
1	115 (64.97)	62 (35.03)
2	34 (70.83)	14 (29.17)
3	6 (50)	6 (50)
4	14 (66.67)	7 (33.33)

Sample characteristics (N=382)	No decline (n=229) n (%)	With decline (n=153) n (%)	p value
Functional capacity
Independent	164 (68)	77 (32)	0.000
Semi-dependent	40 (65)	21 (34.4)
Dependent	25 (31.2)	55 (68)
	M (+DP)	M (+DP)
Days of hospitalization	15.40 (11.56)	17.25 (17.89)	0.682
INTERMED
Biological domain	7.80 (2.42)	8.47 (2.44)	0.005
Psychological domain	1.57 (2.35)	3.50 (3.19)	0.000
Social domain	2.20 (2.30)	3.95 (3.65)	0.000
Health system domain	4.27 (1.90)	4.38 (1.92)	0.385
INTERMED Total	15.88 (5.80)	20.39 (7.79)	0.000
Care complexity
0 \|- 20	183 (69.8)	79 (30.2)	0.000
21 \|- +	46 (38.3)	74 (61.7)

Model 1 Sociodemographic characteristics	B (SE)	OR	CI (95%)	p value
Age	0.33 (0.13)	1.03	1.01-1.06	0.010
Schooling	-0.881 (0.22)	0.41	0.26-0.64	0.000
Marital status (no partner)	0.51 (0.22)	1.67	1.08-2.58	0.020
Constant (B0)	-2.26 (0.951)			0.017
Model 2 Sociodemographic and health characteristics	B (SE)	OR	CI (95%)	p value
Age	0.27 (0.13)	1.03	1.002-1.05	0.033
Schooling	-0.87 (0.23)	0.41	0.26-0.64	0.000
Marital status (no partner)	0.41 (0.22)	1.51	0.97-2.37	0.067
Katz (1 or more difficulty)	0.75 (0.23)	2.11	1.37-3.33	0.001
Constant (B0)	-2.09 (0.94)			0.028
Model 3 Sociodemographic and health characteristics, and measures of the INTERMED method^* * Final model: chi-square of the model of 80.52, degrees of freedom: 5, p.0,000. R2 = 0.257; B - Beta; CI - Confidence Interval; OR - Odds Ratio; SE - Standard Error; The variables age and schooling were continuous and the reference condition for marital status was the married group, and for Katz - functional dependence, the group of independent elderly.	B (SE)	OR	CI (95%)	p value
Age	0.33 (0.01)	1.03	1.01-1.06	0.018
Schooling	-0.98 (0.24)	0.37	0.23-0.59	0.000
Marital status (no partner)	0.34 (0.23)	1.41	0.89-2.25	0.141
Katz (1 or more difficulty)	0.440 (0.24)	1.55	0.95-2.52	0.075
Psychological domain	0.24 (0.04)	1.27	1.16-1.38	0.000
Constant (B0)	-2.79 (1.02)			0.006

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[1] Corresponding Author: Henrique Salmazo da Silva. E-mail: henriquesalmazo@yahoo.com.br