Delirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation. Prospective cohort study. Hospital rehabilitation unit. A total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006. Dementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations. The median age was 77 years (interquartile range: 71-83). The prevalence of DSD was 8%, and the prevalence of delirium and dementia alone were 4% and 22%, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio [OR] 15.5; 95% Confidence Interval [CI] 5.6-42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95% CI 2.8-8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1-2.8; P = .01). DSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.

Objectives: To use the most recently available population‐based data to estimate potentially inappropriate medication ( PIM ) prevalence under the 2012 update of the Beers list of PIM s and to provide a benchmark from which to measure future changes. Design: Retrospective cohort study using nationally representative data. Setting: 2006–2010 Medical Expenditure Panel Survey ( MEPS ). Participants: Community‐dwelling sample of U.S. older adults (N = 18,475). Measurements: The updated Beers criteria were operationalized, generating a “broad” PIM definition that incorporated form, route, or dose restrictions where clearly specified and a “qualified” definition that applied specific exceptions where mentioned in the rationale associated with each drug category. Bivariate analyses described PIM prevalence, comparing the two operational definitions, and examined time trends. Results: Of older adults with prescription medications, 42.6% had at least one medication fill that met the broad definition, with nonsteroidal anti‐inflammatory drugs ( NSAID s) having the highest prevalence (10.9%). The rate declined from 45.5% in 2006–2007 to 40.8% in 2009–2010. The categories with the largest absolute decline were NSAID s, selected sulfonylureas, and estrogens. PIM prevalence was 30.9% using the qualified definition. Conclusion: Despite the overall high use of PIM s, there has been a decline observed in recent years. Future studies should test the effect of educational and clinical interventions on changes in PIM use and outcomes. The current study results can aid in targeting these interventions.