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(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.
doi: 10.1093/ageing/afy103 All rights reserved. For permissions, please email: journals.permissions@oup.com
Published electronically 11 July 2018
Over half of older hospital inpatients have co-existing cog- ‘assent’ since it is unlikely that all patients lacking capacity
nitive impairment but the majority do not have a preadmis- had power of attorney or equivalent in situ. The conflicting
sion diagnosis of dementia [1]. Delirium (acute confusional ethical considerations of meeting study consent require-
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Editorials
by participants signalling each time an ‘A’ was heard when Conflict of interest
‘S-A-V-E-A-H-A-A-R-T’ was read out) may also be useful
in patients with co-existent dementia [10]. However, ques- None.
tions remain around how best to implement screening in
routine clinical practice. Strategies need to be adapted Funding
according to clinical setting: in acute secondary care ser-
vices, physical illness is the focus and thorough clinical None.
work-up is routine, the clinical challenges are around the
detection of co-morbid cognitive disorders (known vs. SARAH T. PENDLEBURY1,2
1
unknown dementia/MCI, transient cognitive impairment, Departments of General (Internal) Medicine and Geratology, John
delirium) with implications for communication, capacity Radcliffe hospital, Oxford OX3 9DU, UK
2
and consent processes, discharge planning and long-term Centre for Prevention of Stroke and Dementia, Nuffield
636
Editorials
12. Bellelli G, Morandi A, Davis DH et al. Validation of the 4AT, to acute medicine: Abbreviated Mental Test Score (AMTS)
a new instrument for rapid delirium screening: a study in 234 and subjective memory complaint versus Montreal Cognitive
hospitalised older people. Age Ageing 2014; 43: 496–502. Assessment and IQCODE. Age Ageing 2015; 44:
13. Jackson TA, MacLullich AM, Gladman JR, Lord JM, 1000–5.
Sheehan B. Undiagnosed long-term cognitive impairment in 15. Pendlebury ST, Lovett NG, Smith SC, Wharton R, Rothwell
acutely hospitalised older medical patients with delirium: a PM. Delirium risk stratification in consecutive unselected admis-
prospective cohort study. Age Ageing 2016; 45: 493–9. sions to acute medicine: validation of a susceptibility score based
14. Pendlebury ST, Klaus SP, Mather M, de Brito M, Wharton on factors identified externally in pooled data for use at entry to
R. Routine cognitive screening in older patients admitted the acute care pathway. Age Ageing 2017; 46: 226–31.
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