Cognitive decline after hospitalization in a community population of older persons
Abstract
Objective:
To test the hypothesis that hospitalization in old age is associated with subsequent cognitive decline.
Methods:
As part of a longitudinal population-based cohort study, 1,870 older residents of an urban community were interviewed at 3-year intervals for up to 12 years. The interview included a set of brief cognitive tests from which measures of global cognition, episodic memory, and executive function were derived. Information about hospitalization during the observation period was obtained from Medicare records.
Results:
During a mean of 9.3 years, 1,335 of 1,870 persons (71.4%) were hospitalized at least once. In a mixed-effects model adjusted for age, sex, race, and education, the global cognitive score declined a mean of 0.031 unit per year before the first hospitalization compared with 0.075 unit per year thereafter, a more than 2.4-fold increase. The posthospital acceleration in cognitive decline was also evident on measures of episodic memory (3.3-fold increase) and executive function (1.7-fold increase). The rate of cognitive decline after hospitalization was not related to the level of cognitive function at study entry (r = 0.01, p = 0.88) but was moderately correlated with rate of cognitive decline before hospitalization (r = 0.55, p = 0.021). More severe illness, longer hospital stay, and older age were each associated with faster cognitive decline after hospitalization but did not eliminate the effect of hospitalization.
Conclusion:
In old age, cognitive functioning tends to decline substantially after hospitalization even after controlling for illness severity and prehospital cognitive decline.
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Information & Authors
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Copyright
Copyright © 2012 by AAN Enterprises, Inc.
Publication History
Received: June 22, 2011
Accepted: November 28, 2011
Published online: March 21, 2012
Published in print: March 27, 2012
Disclosure
Dr. Wilson serves as a Consulting Editor for Aging, Neuropsychology, and Cognition and Psychology and Aging; has served as a consultant to Pain Therapeutics, Inc; and receives research support from the NIH/NIA. Dr. Hebert receives research support from the NIH/NIA. Dr. Scherr reports no disclosures. Dr. Dong receives support from the NIH/NIA. Dr. Leurgans receives research support from the NIH/NIA. Dr. Evans has served on a data monitoring committee for Eli Lily and Company and received research support from the NIH.
Authors
Author Contributions
Drafting/revising the manuscript for content: Dr. Wilson, Dr. Hebert, Dr. Scherr, Dr. Dong, Dr. Evans. Study concept or design: Dr. Wilson, Dr. Hebert, Dr. Dong, Dr. Leurgans. Analysis or interpretation of data: Dr. Wilson, Dr. Hebert, Dr. Dong, Dr. Leurgans. Acquisition of data: Dr. Evans. Statistical analysis: Dr. Hebert, Dr. Leurgans. Study supervision or coordination: Dr. Evans. Obtaining funding: Dr. Evans.
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Wilson et al. discuss older patients experiencing cognitive decline after hospitalization [1] and suggest that older patients might benefit from care in emergency departments with discharge to their home versus hospitalization.
After care in emergency rooms, however, older patients also suffer functional decline and are at greater risk of medical complications. [2] Care in most emergency departments is not well suited to care of the elderly. Rapid triage is not appropriate for older patients who have complex problems. Rapid diagnosis and treatment may be inadequate as well since the acute problem may be subtle and not discoverable under the time pressure of most busy emergency rooms. [2]
Recent publications have outlined ways to improve quality of care for seniors in emergency departments and reduce hospitalization rates. [2,3] Implementation of geriatric emergency departments with assessment by an interdisciplinary team of geriatrician, social worker, and nurse discharge coordinator with plans for rapid follow-up by the primary care physician might decrease return rates and need for hospitalization. [2] In addition, emergency department geriatric observation units that would allow for longer periods for assessment and management of older patients prior to discharge may decrease admissions to the hospital. [3]
1. Wilson RS, Herbert LE, Scherr PA, et al. Cognitive decline after hospitalization in a community population of older persons. Neurology 2012;78:950-956.
2. Hwang U, Morrison RS. The Geriatric Emergency Department. JAGS 2007;55:1873-1876.
3. Foo CL, Siu VWY, Tan TL, et al. Innovations in Aged Care- Geriatric assessment and intervention in an emergency department observation unit reduced re-attendance and hospitalization rates. Australasian J on Ageing 2012;31:40-46.
For disclosures, contact the editorial office at [email protected].