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Race and Documentation of Cognitive Impairment in Hospitalized Older Adults
Author(s) -
Campbell Noll L.,
Cantor Braca B.,
Hui Siu L.,
Perkins Anthony,
Khan Babar A.,
Farber Mark O.,
Nazir Arif,
Garrett Stephanie L.,
Ely E. Wesley,
Boustani Malaz A.
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12691
Subject(s) - medicine , race (biology) , documentation , cognitive impairment , gerontology , cognition , medline , psychiatry , botany , computer science , political science , law , biology , programming language
Objectives To evaluate whether race influences agreement between screening results and documentation of cognitive impairment and delirium. Design Secondary data analysis. Setting An urban, public hospital and healthcare system. Participants Hospitalized older adults aged 65 and older admitted to general inpatient medical services evaluated for cognitive impairment (n = 851) and evaluated for delirium (n = 424). Measurements Cognitive impairment and delirium were measured in each participant using the Short Portable Mental Status Questionnaire ( SPMSQ ) and the Confusion Assessment Method ( CAM ), respectively, as the reference identification method. Clinical documentation of cognitive impairment and delirium was defined according to the presence of International Classification of Diseases, Ninth Revision ( ICD ‐9), codes from within 1 year before hospitalization through discharge for cognitive impairment or from hospital admission through discharge for delirium. Results Two hundred ninety‐four participants (34%) had cognitive impairment based on SPMSQ performance, and 163 (38%) had delirium based on CAM results. One hundred seventy‐one (20%) of those with cognitive impairment had an ICD ‐9 code for cognitive impairment, whereas 92 (22%) of those with delirium had an ICD ‐9 code for delirium. After considering age, sex, education, socioeconomic status, chronic comorbidity, and severity of acute illness, of those who screened positive on the SPMSQ , African Americans had a higher adjusted odds ratio ( AOR ) than non‐African Americans for clinical documentation of cognitive impairment ( AOR = 1.66, 95% confidence interval ( CI ) = 0.95–2.89), and of those who screened negative on the SPMSQ , African Americans had higher odds of clinical documentation of cognitive impairment ( AOR = 2.10, 95% CI = 1.17–3.78) than non‐African Americans. There were no differences in clinical documentation rates of delirium between African Americans and non‐African Americans. Conclusion Racial differences in coding for cognitive impairment may exist, resulting in higher documentation of cognitive impairment in African Americans screening positive or negative for cognitive impairment.