{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:10:29Z","timestamp":1789578629198,"version":"build-2803163510"},"reference-count":34,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009270","name":"Invention for Innovation","doi-asserted-by":"publisher","award":["NIHR20490"],"award-info":[{"award-number":["NIHR20490"]}],"id":[{"id":"10.13039\/501100009270","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000697","name":"Rhodes Scholarships","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000697","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013373","name":"NIHR Oxford Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013373","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024811","name":"Nuffield Department of Population Health, University of Oxford","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100024811","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","thelancet.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["eClinicalMedicine"],"published-print":{"date-parts":[[2025,12]]},"DOI":"10.1016\/j.eclinm.2025.103641","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T21:46:10Z","timestamp":1764020770000},"page":"103641","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"special_numbering":"C","title":["Prevalence of cognitive morbidity including delirium in 51,202 emergency hospital admissions across 29 medical and surgical specialties in ORCHARD-EPR: a cross-sectional study"],"prefix":"10.1016","volume":"90","author":[{"given":"Emily Louise","family":"Boucher","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Catherine","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhir","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6384-8322","authenticated-orcid":false,"given":"Sasha","family":"Shepperd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3603-8388","authenticated-orcid":false,"given":"Sarah Tamsin","family":"Pendlebury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.eclinm.2025.103641_bib1","series-title":"Geriatric medicine: GIRFT programme national specialty reports","author":"Hopper","year":"2021"},{"key":"10.1016\/j.eclinm.2025.103641_bib2","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2023.101947","article-title":"Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts","volume":"59","author":"Boucher","year":"2023","journal-title":"eClinicalMedicine"},{"key":"10.1016\/j.eclinm.2025.103641_bib3","article-title":"Observational, longitudinal study of delirium in over 1800 consecutive unselected acute general (internal) medicine patients: age-specific occurrence, associated factors, and outcomes to 10-years","volume":"6","author":"Gan","year":"2025","journal-title":"Lancet Healthy Longev"},{"key":"10.1016\/j.eclinm.2025.103641_bib4","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/s41572-020-00223-4","article-title":"Delirium","volume":"6","author":"Wilson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"10.1016\/j.eclinm.2025.103641_bib5","series-title":"BGS position statement: person-centred acute hospital care for people with dementia","author":"Harwood","year":"2022"},{"key":"10.1016\/j.eclinm.2025.103641_bib6","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1186\/s12916-019-1458-7","article-title":"Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day","volume":"17","year":"2019","journal-title":"BMC Med"},{"key":"10.1016\/j.eclinm.2025.103641_bib7","article-title":"Retrospective delirium ascertainment from case notes: a retrospective cohort study","volume":"11","year":"2021","journal-title":"BMJ Open"},{"key":"10.1016\/j.eclinm.2025.103641_bib8","article-title":"Delirium is under-reported in discharge summaries and in hospital administrative systems: a systematic review","volume":"2023","author":"Ibitoye","year":"2023","journal-title":"Delirium"},{"key":"10.1016\/j.eclinm.2025.103641_bib9","doi-asserted-by":"crossref","first-page":"454","DOI":"10.7861\/clinmed.2019-0470","article-title":"Impact of a system-wide multicomponent intervention on administrative diagnostic coding for delirium and other cognitive frailty syndromes: observational prospective study","volume":"20","author":"Pendlebury","year":"2020","journal-title":"Clin Med"},{"key":"10.1016\/j.eclinm.2025.103641_bib10","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1192\/bjp.bp.108.055335","article-title":"Dementia in the acute hospital: prospective cohort study of prevalence and mortality","volume":"195","author":"Sampson","year":"2009","journal-title":"Br J Psychiatry"},{"issue":"44","key":"10.1016\/j.eclinm.2025.103641_bib11","first-page":"733","article-title":"The prevalence of dementia and cognitive impairment in hospitals","volume":"115","author":"Bickel","year":"2018","journal-title":"Dtsch Arztebl Int"},{"issue":"6","key":"10.1016\/j.eclinm.2025.103641_bib12","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1093\/ageing\/afv131","article-title":"Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition","volume":"44","author":"Timmons","year":"2015","journal-title":"Age Ageing"},{"key":"10.1016\/j.eclinm.2025.103641_bib13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-085126","article-title":"Protocol for the development and analysis of the Oxford and Reading Cognitive Comorbidity, Frailty and Ageing Research Database-electronic Patient Records (ORCHARD-EPR)","volume":"14","author":"Boucher","year":"2024","journal-title":"BMJ Open"},{"key":"10.1016\/j.eclinm.2025.103641_bib14","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: the confusion assessment method. A new method for detection of delirium","volume":"113","author":"Inouye","year":"1990","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.eclinm.2025.103641_bib15","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ageing\/1.4.233","article-title":"Evaluation of a mental test score for assessment of mental impairment in the elderly","volume":"1","author":"Hodkinson","year":"1972","journal-title":"Age Ageing"},{"key":"10.1016\/j.eclinm.2025.103641_bib19","series-title":"National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS","year":"2012"},{"key":"10.1016\/j.eclinm.2025.103641_bib20","series-title":"IAP00385 Summary Hospital-level Mortality Indicator (SHMI)","first-page":"81","year":"2020"},{"issue":"10132","key":"10.1016\/j.eclinm.2025.103641_bib21","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1016\/S0140-6736(18)30668-8","article-title":"Development and validation of a hospital frailty risk score focusing on older people in acute care settings using electronic hospital records: an observational study","volume":"391","author":"Gilbert","year":"2018","journal-title":"Lancet"},{"key":"10.1016\/j.eclinm.2025.103641_bib16","article-title":"Implementation of delirium screening at scale in older patients with emergency hospital admission","volume":"27","author":"Boucher","year":"2025","journal-title":"JAMA Intern Med"},{"issue":"10","key":"10.1016\/j.eclinm.2025.103641_bib17","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afaf284","article-title":"Delirium prevalence, diagnostic uncertainty and outcomes in ORCHARD-EPR: validation against prospective reference cohorts","volume":"54","author":"Boucher","year":"2025","journal-title":"Age Ageing"},{"key":"10.1016\/j.eclinm.2025.103641_bib18","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1093\/ageing\/afu021","article-title":"Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people","volume":"43","author":"Bellelli","year":"2014","journal-title":"Age Ageing"},{"key":"10.1016\/j.eclinm.2025.103641_bib22","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1016\/j.jamda.2022.01.051","article-title":"Discharge destinations of delirious patients: findings from a prospective cohort study of 27,026 patients from a large health care system","volume":"23","author":"Zipser","year":"2022","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"10.1016\/j.eclinm.2025.103641_bib23","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-017-0899-0","article-title":"Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions","volume":"15","author":"Reynish","year":"2017","journal-title":"BMC Med"},{"key":"10.1016\/j.eclinm.2025.103641_bib24","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1159\/000509357","article-title":"Underestimation of cognitive impairment in older inpatients by the abbreviated mental test score versus the montreal cognitive assessment: cross-sectional observational study","volume":"10","author":"Emery","year":"2020","journal-title":"Dement Geriatr Cogn Dis Extra"},{"key":"10.1016\/j.eclinm.2025.103641_bib25","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/S0140-6736(13)61570-6","volume":"382","author":"Matthews","year":"2013","journal-title":"Lancet"},{"key":"10.1016\/j.eclinm.2025.103641_bib26","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1111\/jgs.18751","article-title":"Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: a systematic review","volume":"72","author":"Penfold","year":"2024","journal-title":"J Am Geriatr Soc"},{"key":"10.1016\/j.eclinm.2025.103641_bib34","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12877-020-01942-9","article-title":"Factors associated with admission to bed-based care: observational prospective cohort study in a multidisciplinary same day emergency care unit (SDEC)","volume":"21","author":"Elias","year":"2021","journal-title":"BMC Geriatr"},{"key":"10.1016\/j.eclinm.2025.103641_bib27","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afad171","article-title":"Decision-making capacity in older medical in-patients: frequency of assessment and rates of incapacity by decision-type and underlying brain\/mind impairment","volume":"52","author":"Gan","year":"2023","journal-title":"Age Ageing"},{"key":"10.1016\/j.eclinm.2025.103641_bib28","article-title":"Comprehensive geriatric assessment for older adults admitted to hospital","volume":"9","author":"Ellis","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.eclinm.2025.103641_bib29","doi-asserted-by":"crossref","first-page":"e131","DOI":"10.1016\/S2666-7568(23)00266-0","article-title":"Infection, delirium, and risk of dementia in patients with and without white matter disease on previous brain imaging: a population-based study","volume":"5","author":"Pendlebury","year":"2024","journal-title":"Lancet Healthy Longev"},{"key":"10.1016\/j.eclinm.2025.103641_bib30","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1016\/S2666-7568(22)00013-7","article-title":"The effect of baseline cognition and delirium on long-term cognitive impairment and mortality: a prospective population-based study","volume":"3","author":"Tsui","year":"2022","journal-title":"Lancet Healthy Longev"},{"key":"10.1016\/j.eclinm.2025.103641_bib31","doi-asserted-by":"crossref","first-page":"e399","DOI":"10.1016\/S2666-7568(23)00098-3","article-title":"Delirium, neurofilament light chain, and progressive cognitive impairment: analysis of a prospective Norwegian population-based cohort","volume":"4","author":"Krogseth","year":"2023","journal-title":"Lancet Healthy Longev"},{"key":"10.1016\/j.eclinm.2025.103641_bib32","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afaf144","article-title":"Using scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions","volume":"54","author":"Penfold","year":"2025","journal-title":"Age Ageing"},{"key":"10.1016\/j.eclinm.2025.103641_bib33","doi-asserted-by":"crossref","first-page":"3116","DOI":"10.1161\/STROKEAHA.111.621490","article-title":"Transient cognitive impairment in TIA and minor stroke","volume":"42","author":"Pendlebury","year":"2011","journal-title":"Stroke"}],"container-title":["eClinicalMedicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2589537025005759?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2589537025005759?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:50:06Z","timestamp":1773928206000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2589537025005759"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":34,"alternative-id":["S2589537025005759"],"URL":"https:\/\/doi.org\/10.1016\/j.eclinm.2025.103641","relation":{},"ISSN":["2589-5370"],"issn-type":[{"value":"2589-5370","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Prevalence of cognitive morbidity including delirium in 51,202 emergency hospital admissions across 29 medical and surgical specialties in ORCHARD-EPR: a cross-sectional study","name":"articletitle","label":"Article Title"},{"value":"eClinicalMedicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.eclinm.2025.103641","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Author(s). Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"103641"}}