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Cognitive Status Upon Hospital Discharge Vs SNF Admission

July 31, 2017

Researchers conducted a retrospective cohort study and found that hospital diagnoses of dementia may not always reflect older adults’ cognitive status upon admission to a skilled-nursing facility (SNF).

Brian Downer, PhD, University of Texas Medical Branch, Galveston, TX, and coauthors looked at a national sample of Medicare fee-for-service beneficiaries in SNFs in the United States. Specifically, authors looked at beneficiaries newly admitted to a SNF within 3 days of discharge from an acute hospital between 2013-2014 (N = 1,885,015).
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ICD-9 CM codes from the Medicare Provider Analysis and Review (MedPAR) Part A file were used to identify individuals with a discharge diagnosis of dementia. Possible classifications of cognitive status upon SNF admission included “cognitively intact,” “mildly impaired,” “moderately impaired,” or “severely impaired” according to the Cognitive Function Scale using items in the Minimum Data Set 3.0.

Researchers found that, of beneficiaries with a dementia diagnosis (n = 252, 970), 17.9% were classified as cognitively intact, 25.8% were mildly impaired, and 56.3% were moderately or severely impaired on SNF admission. Of beneficiaries without a hospital diagnosis of dementia, 65% were cognitively intact upon admission to an SNF, and 13.1% were classified as moderately or severely impaired (J Am Med Dir Assoc. 2017;18[8]:726-728).

According to authors, these findings imply that Medicare beneficiaries who are discharged from the hospital with a diagnosis of dementia are often classified as cognitively intact or mildly impaired upon admission to an SNF. These results provide evidence that hospital classifications regarding cognition may not always reflect older adults’ cognitive status at admission to SNFs.—Amanda Del Signore



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