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Cognitive status and behavioral problems in older hospitalized patients

Ruth O'Hara1*, Martin S Mumenthaler1, Helen Davies2, Erin L Cassidy12, Martha Buffum3, Sarojini Namburi2, Roxanne Shakoori2, Claire E Danielsen1, Patricia Tsui2, Art Noda2, Helena C Kraemer1 and Javaid I Sheikh12

Author Affiliations

1 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA., United States

2 Veterans Affairs Palo Alto Health Care System, Palo Alto, CA., United States

3 Veterans Affairs Medical Center, San Francisco, CA., United States

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Annals of General Hospital Psychiatry 2002, 1:1  doi:10.1186/1475-2832-1-1

Published: 27 September 2002



(a) To determine the quantity and quality of behavioral problems in older hospitalized patients on acute care units; (b) to determine the burden of these behaviors on staff; and (c) to identify predictors of behavioral problems.


Upon admission, patients performed the Mini-Mental State Exam (MMSE), the Geriatric Depression Scale (GDS), and information was obtained on age, ethnicity, level of education, living arrangement, and psychiatric history. Two days post-admission, a clinical staff member caring for each patient, performed the Neuropsychiatric Inventory-Questionnaire (NPI-Q) to assess patients' behavioral problems and staff distress.

Participants and setting

Forty-two patients, over 60 years of age, admitted to medical and surgical units of the Veterans Affairs Hospitals in Palo Alto and San Francisco, participated.


Twenty-three of 42 (55%) patients exhibited behavioral problems. Anxiety, depression, irritability, and agitation/aggression were the most frequently observed behaviors. The severity of the behavioral problems was significantly correlated with staff distress. Lower performance on the MMSE at admission was significantly associated with higher NPI-Q ratings. Specifically, of those cases with scores less than or equal to 27 on the MMSE, 66% had behavioral problems during hospitalization, compared to only 31% of those with scores greater than 27.


Behavioral problems in older hospitalized patients appear to occur frequently, are a significant source of distress to staff, and can result in the need for psychiatric consultation. Assessment of the mental status of older adults at admission to hospital may be valuable in identifying individuals at increased risk for behavioral problems during hospitalization.

Acute Care; Older Patients; Agitation; Cognition