A gero-informatics tool to enhance the care of hospitalized older adults with cognitive impairment

Figures & data

Figure 1 The impact of gero-informatics on healthcare.

Table 1 Impact of cognitive impairment on hospitalized elders

Higher rates of hospital-acquired complications: Falls and fractures Pressure ulcers Injuries (pulling intravenous, Foley) Medication errors Physical restraints Higher mortality Poorer functional performance Longer length of hospital stay Higher probability of post-hospital institutionalization Higher healthcare expenditure

Table 2 The list of anticholinergic medications to avoid in hospitalized elders with cognitive impairment

Drug	Alternatives
Meperidine	Morphine sulfate, oxycodone (or hydrocodone) with Acetaminophen
Promethazine	Dolasetron, metoclopramide
Diphenhydramine	Loratadine for allergic reactions, itching, or urticaria Trazodone for assistance with sleeping Acetaminophen, low dose diphenhydramine, or hydrocortisone for blood transfusion
Hydroxyzine	Loratadine for allergic reactions, itching, or urticaria Trazodone for assistance with sleeping
Chlorpheniramine	Loratadine for allergic reactions, itching, or urticaria Trazodone for assistance with sleeping
Meclizine	Hold while patient in the hospital
Cyclobenzaprine	Acetaminophen or oxycodone with acetaminophen
Methocarbamol	Acetaminophen or oxycodone with acetaminophen
Hyoscyamine	Morphine sulfate for painful cramps Proton pump inhibitor for reflux disorders
Oxybutynin	Hold while patient in the hospital
Tolterodine	Hold while patient in the hospital
Paroxetine	Sertraline
Amitriptyline	Trazodone for assistance with sleeping Referral to ACE for depression Gabapentin (or Duloxetine?) for neuropathic pain
Amoxapine	Referral to ACE for depression
Doxepin	Trazodone for assistance with sleeping Referral to ACE for depression Loratadine for itching
Imipramine	Trazodone for assistance with sleeping Referral to ACE for depression
Nortriptyline	Trazodone for assistance with sleeping Referral to ACE for depression Gabapentin (or duloxetine?) for neuropathic pain
Benztropine	Hold while in the hospital and observe for extrapyramidal sign

Abbreviations: ACE, acute care for elders.

Table 3 Alternatives for the use of physical restraint and Foley catheterization among patients with cognitive impairment

Physical restraints	Delirium evaluation A sitter as needed to help assure a safe environment for the patient. Low dose haloperidol or trazodone for aggressive and unsafe agitated behaviors. Evaluate the continuous need for the medication within 24 hours.
Foley catheterization	Reconsider the need for Foley catheter in the presence of cognitive impairment.