Demented versus non-demented very old inpatients: the same comorbidities but poorer functional and nutritional status
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BACKGROUND: demented patients have been reported to be healthier than other old people of the same age. OBJECTIVES: to assess comorbid conditions, functional and nutritional status in medically ill hospitalised patients with normal cognition or affected by dementia of various causes and severities, or mild cognitive impairment (MCI). DESIGN AND SETTING: a prospective study was carried out, between January and December 2004, in the Rehabilitation and Geriatric Hospital (HOGER). METHODS: activities of daily living (ADL), instrumental activities of daily living (IADL) and mini nutritional assessment (MNA) scores were assessed as a function of the status of the patient two weeks before admission to hospital. On admission, cognitive status was assessed by a systematic battery of neuropsychological tests, comorbid conditions were assessed with the Charlson comorbidity index (CCI), and body mass index (BMI) and functional independence measure (FIM) were determined. BMI and FIM were also determined on discharge. RESULTS: we studied 349 patients (mean age 85.2 +/- 6.7; 76% women): 161 (46.1%) cognitively normal, 37 (10.6%) with MCI and 151 (43.3%) demented (61 Alzheimer's disease (AD), 62 mixed dementia (MD) and 17 vascular dementia (VaD)). ADL, IADL, FIM and MNA scores on admission decreased with cognitive status, regardless of the type of dementia. Functionality at discharge remained significantly lower in demented patients than in other patients. CCI was high and similar in all three groups (mean 4.6 +/- 2.7). Patients with VaD had poorer health than other demented patients, with a higher average comorbidity score, more frequent hypertension, stroke and hyperlipidaemia. Comorbidity did not increase with severity levels of dementia. CONCLUSIONS: in this cohort of very old inpatients, demented patients, non-demented patients and patients with MCI had similar levels of comorbidity, but demented patients had a poorer functional and nutritional status.
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Evidence linked this to poorer functional and nutritional status, and increased risk of undetected illnesses at discharge (CMOC5).
“For example, evidence linked this to poorer functional and nutritional status, and increased risk of undetected illnesses at discharge (CMOC5) [54, 77, 78].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [78]
The Discussion reports poorer functional and nutritional status in hospitalised patients with dementia and says their other illnesses are more likely to remain undiagnosed. It does not establish that illnesses remained undetected specifically at discharge; the discharge findings concern functional status. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOlder adults with dementia typically stay longer in hospital.
“Analysis suggested that pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled these beliefs, as older adults with dementia typically stay longer in hospital [41, 43, 48, 50, 75, 78, 84, 89, 91–93].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [78]
The Results and Discussion compare patients with and without dementia on functional status, nutrition and comorbidities, but do not compare their hospital stays. Table 1 reports length of stay for the study cohort versus excluded and nonparticipating patients, not by dementia status (page unavailable). Searches for “length of stay” and hospitalization duration found no dementia-specific comparison. (LLM, conf=0.77)
Experimental — accuracy not yet measuredPressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled healthcare professionals' beliefs about patients with MLTCiD.
“Analysis suggested that pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled these beliefs, as older adults with dementia typically stay longer in hospital [41, 43, 48, 50, 75, 78, 84, 89, 91–93].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [78]
The Results compare patients by cognitive status but do not report whether those with dementia stayed longer. Table 1 (labelled Key points in our copy; page unavailable) gives length of stay for the study cohort and excluded or refusing patients, not for dementia versus non-dementia groups. Searches for length of stay and longer hospital stays found no passage establishing the cited rationale; the statement about occupancy pressure is the citing authors’ own analysis. (LLM, conf=0.75)
Experimental — accuracy not yet measuredThere is a clear lack of appropriate knowledge and training for healthcare professionals on dementia, which had a knock-on effect on discharge planning and patient access to services.
“Our findings suggest that there is a clear lack of appropriate knowledge and training for HCPs on dementia, which had a knock-on effect on discharge planning and patient access to services [46, 50, 51, 54, 59, 61, 73, 74, 77, 78, 80–86].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [78]
The Discussion reports that comorbidities in patients with dementia may go undiagnosed and calls for better detection by health professionals. It does not assess professionals’ dementia knowledge or training, or link either to discharge planning or access to services. Searches for those terms found no supporting passage; references to discharge concern patients’ functional status. (LLM, conf=0.76)
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References 32 · Cited by 198
- Authors
- Zekry, D., Herrmann, F. R., Grandjean, R., Meynet, M.-P., Michel, J.-P., Gold, G., & Krause, K.-H.
- Affiliations
- University of Geneva (CH)
- Corresponding author
- Zekry, Dina
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-10-30
- Volume
- 37
- Issue
- 1
- Pages
- 83-89
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W2112985742
- Cited by
- 198
- References
- 32
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 10 · 2022: 8 · 2021: 7 · 2020: 9 · 2019: 4 · 2018: 12 · 2017: 11 · 2016: 10 · 2015: 12 · 2014: 20 · 2013: 15 · 2012: 19
- FWCI
- 4.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Age and Ageing (publishedVersion)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- dementia, mild cognitive impairment, comorbidities, functional status, nutritional status, activities of daily living, instrumental activities of daily living, Alzheimer's disease, vascular dementia, mixed dementia, hospitalized older adults, functional independence
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Alzheimer Disease, Cardiovascular Diseases, Cognition Disorders, Dementia, Female, Follow-Up Studies, Hospitalization, Humans, Male, Neuropsychological Tests, Nutritional Status, Prospective Studies, Risk Factors, Dementia, Vascular, Nutrition Assessment, Comorbidity, Body Mass Index
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