Planning Postdischarge Care with Cognitively Impaired Adults


A patient performs the CLOX 1, a clock-drawing task used to assess patients for cognitive impairment. Photo by Ed Eckstein.

By Shawn Kennedy, AJN editor-in-chief

The transition from hospital to home can be fraught with pitfalls, especially if the patient in question is an older adult with multiple conditions and a not-so-prepared caregiver. The transitional care model, in which NPs coordinate care and provide follow-up care after discharge, has been shown to be successful in reducing hospital readmissions in this group of patients.

With Medicare levying penalties on hospitals with higher-than-average readmissions rates, the stakes aren’t just high for patients and their families. Might similar models of care also work with cognitively impaired adults?

In “Studying Nursing Interventions in Acutely Ill, Cognitively Impaired Older Adults,” a feature article in AJN‘s October issue (free until the end of October), Kathleen McCauley and colleagues from the University of Pennsylvania seek to answer this question, among others.

In the article, McCauley and colleagues describe the methodology and protocols used in their study, summarize their findings, and discuss some of the challenges in conducting research in the clinical setting. Among their findings is the important lesson that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as the need for hospitals to make cognitive screening of older adults who are hospitalized for an acute condition “a standard of care.”

Here’s the article’s overview:

Although it increases the risk of poor outcomes and raises the costs of care, cognitive impairment in hospitalized older adults is often neither accurately identified nor well managed. In conducting a two-phase, comparative-effectiveness clinical trial of the effects of three nursing interventions—augmented standard care, resource nurse care, and the transitional care model—on hospitalized older adults with cognitive deficits, a team of researchers encountered several challenges. For example, in assessing potential subjects for the study, they found that nearly half of those assessed had cognitive impairment, yet many family caregivers could not be identified or had no interest in participating in the study. One lesson the researchers learned was that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as address the complex process of managing postdischarge care.

For the authors’ more direct perspective on the issues addressed in the article, listen to our podcast interview.

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And for more on issues associated with patient discharge and education and the prevention of readmissions, see also:

“Cognitively Impaired Older Adults: From Hospital to Home: an exploratory study of these patients and their caregivers,” a CE feature article from several years ago

“Preparing Patients to Care for Themselves,” a Viewpoint essay we published in July by the influential patient advocate and long-term cancer patient Jessie Gruman shortly before her death. (The focus of this essay is not on cognitively impaired older adults, but does highlight some issues faced by all patients after a major illness or surgery.)

“Transitional Care” (an excellent overview of the model by key theorists)


Managing editor, American Journal of Nursing

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