2323 Prevalence of delirium, dementia and cognitive test deficits, hospital-wide and by specialty in 50,000 unplanned admissions

Abstract Introduction Over one-third of older people with unplanned admissions to hospital are frail, but data on the burden of delirium, dementia and other cognitive frailty are lacking. Reliable hospital-wide and specialty-specific prevalence estimates are needed for service-planning including understanding the role of non-geriatricians in caring for this population. Methods ORCHARD includes pseudo-anonymised EPR data for consecutive admissions with a length of stay of 1 day (2017–2019) to four hospitals in Oxfordshire (population = 800,000). Data are collected using a standard cognitive screen comprising dementia history, delirium diagnosis (Confusion Assessment Method-CAM), and 10-point Abbreviated Mental Test-AMTS that is mandated on admission for all patients 70 years. Cognitive frailty was defined as delirium, diagnosed dementia, delirium+dementia or AMTS8 without delirium/dementia. We analysed the ORCHARD data to determine the prevalence of delirium/cognitive frailty trust-wide and by specialty (n = 29 with 50 admissions). Results Among 51,202 admissions with mean/sd age = 82/7 years and Hospital Frailty Risk Score = 8/6, any cognitive frailty was present in 34.5% (95%CI 34.0–34.9%; n = 17,466) of which delirium accounted for 14.6% (n = 7411), delirium+dementia = 9.4% (n = 4757), dementia = 7.5%, (n = 3784), AMTS8 = 3% (n = 1514). The prevalence of cognitive frailty in general medicine, general surgery and trauma/orthopaedics, which accounted for 80% of admissions (n = 41,016), was 41% (n = 13,879), 21% (n = 801) and 35% (n = 1304) in each, respectively. The prevalence was 44% in geriatric medicine admissions (n = 133/301), 36% in palliative (n = 128/356), 29% in stroke (n = 135/468), 27% in infectious disease (n = 41/152), 22% in neurosurgery (n = 154/702) and 10–20% in all other specialties except two. Delirium was the most prevalent form of cognitive frailty in 24/29 specialties. Discussion Cognitive frailty is common in older unplanned hospital admissions across a broad range of specialties, with delirium accounting for most cases. Our findings support the need for hospital-wide and specialty-specific training and service development to reflect the needs of these older complex patients and increased emphasis on delirium in policy.