Should Hospitals Monitor, and Work to Maintain, Patients’ Cognitive Function?

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Hos­pi­tal­iza­tion Linked to More Cog­ni­tive Decline in Elder­ly (Med­scape):

- “Old­er adults have a 2.4‑fold increase in the rate of cog­ni­tive decline after hos­pi­tal­iza­tion, an increased risk that per­sist­ed after adjust­ment for sever­i­ty of ill­ness and length of hos­pi­tal stay, accord­ing to a new study.”

- “As part of the lon­gi­tu­di­nal, pop­u­la­tion-based Chica­go Health and Aging Project, researchers assessed changes in cog­ni­tive func­tion among old­er peo­ple. They used a com­pos­ite of cog­ni­tive tests that assessed episod­ic mem­o­ry (imme­di­ate and delayed recall), exec­u­tive func­tion, and glob­al cog­ni­tion (Mini-Men­tal State Examination).”

- “…And per­haps we should be treat­ing old­er peo­ple with cog­ni­tive impair­ment when they are hos­pi­tal­ized dif­fer­ent­ly than we are now.”

Study: Cog­ni­tive decline after hos­pi­tal­iza­tion in a com­mu­ni­ty pop­u­la­tion of old­er persons

  • 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.