Undiagnosed cognitive impairment in older adults hospitalized in internal medicine wards: Data from the REPOSI registry

A relevant proportion of older adults may have previously undiagnosed cognitive impairment, as reported in several studies enrolling community-dwelling subjects and patients hospitalized in acute settings and nursing homes [1-2]. Cases with undiagnosed cognitive impairment have an increased risk of physical frailty, reduced health status, depression, poor functional recovery after hospitalization and adverse outcomes [1,3-4]. The recognition of cognitive impairment at the earlier stage is an important goal of the geriatric assessment, because this may allow physicians to modify the trajectory of the disease and prevent the resulting functional decline. Moreover, an early diagnosis of cognitive decline allows families to do proper and timely choices on long-care planning, regarding financial and legal affairs and to improve quality of life of patients and caregivers. In this context, a deeper awareness of the related risk factors, predictors and concomitant diseases is very helpful. Considering the high prevalence of multimorbidity, in older adults with undiagnosed cognitive impairment polypharmacy is a relevant issue, because of the related enhanced risk of potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs) [5-7]. Therefore, in these cases a careful evaluation and close revision of each drug appropriateness is warranted [8-9]. To date, data on features, management and clinical impact of undiagnosed cognitive impairment stemming from hospitalized older adults are scarce and heterogeneous. With this background, this study aims to evaluate the prevalence of this condition in a large Italian cohort of older patients hospitalized in internal medicine and geriatrics wards, the use of potentially inappropriate medications among these patients and the related impact on adverse outcomes after hospital discharge.....