Mental decline predicts injury in elderly

Many elderly adults who are in mental decline and live alone may be at high risk of hurting themselves or falling ill, a new study shows.

Of 139 older adults with deteriorating mental function who were followed for 18 months, more than one fifth were injured, developed infections or had other problems as a result of self-neglect or disorientation.

For example, some became dehydrated or delirious because they failed to eat or drink - the most common form of self-neglect in the study. In other cases, poor hygiene or failure to follow medical advice were blamed for infections or injuries.

"One of the greatest concerns that healthcare workers have is the safety of their cognitively impaired senior clients who live alone," lead study author Dr. Mary C. Tierney told Reuters Health.

But there is currently no way to tell which of these patients is at high risk of hazards such as injury, leaving the stove on, wandering or falling victim to fraud, said Tierney, of Sunnybrook and Women's College Health Science Center in Toronto, Ontario.

In her team's study, the greatest risk was found among men and women with chronic obstructive pulmonary disease (COPD) or cerebrovascular diseases such as a history of stroke - as well as those who felt socially isolated or who scored particularly poorly on tests of mental function.

Because primary care doctors can detect these risk factors, the findings may help in identifying which elderly patients need the greatest attention, Tierney and her colleagues report in the September issue of the Journal of the American Geriatrics Society.

The next step, they say, is to use the findings to develop a standard assessment tool that doctors can use to predict patients' risk of harm.

Tierney said they would like to develop a simple booklet that incorporates questions on the risk factors they identified in this study - though more research is needed before they can advocate a specific tool.

Although the cognitively impaired patients in the study all had primary care doctors, Tierney noted that those at greatest risk of harm did not visit their doctors often.

Visits from home healthcare workers - who can spot new health problems and ensure that patients are eating properly and taking their medication - could help keep at-risk elderly out of the hospital or delay their need for nursing home care, according to Tierney.

The study is a "significant contribution" to the effort to improve care for cognitively impaired patients who live on their own, according to an editorial published with the report.

Yet the men and women included in the study may not be those at greatest risk of harm, Dr. Barbara A. Soniat of the George Washington University Medical Center in Washington, D.C., points out.

All of the study patients had a doctor and a family member or friend who saw them at least once a week. Elderly adults without doctors or caregivers, Soniat notes, may face even greater threats to their health and well-being.