Hospitalization Can Speed Cognitive
Decline in the Elderly
Hospitalization of older people might place them at higher risk for accelerated cognitive decline, according to a recent study.
Rates of decline occurred twice as fast among elderly patients on average after a hospital stay compared with their previous rate of decline and with older people not admitted to a health care facility. Some mental change is considered a normal part of aging, but advanced decline is associated with risk of disability and loss of independence, dementia and death.
"Understanding a link to cognitive decline to something as common as a hospital stay is very important," says lead author Robert Wilson, a neuropsychologist at Rush University Medical Center in Chicago. "Hospitals can be a very risky experience for the elderly and we think people need to understand that."
While other experts on aging have noticed the negative impact hospitals have on some elderly patients, the authors say this is the first study "to measure cognitive function enough times before and after hospitalization to determine the effect of hospitalization on the rate of cognitive change."
The study involved 1,870 people ages 65 and older enrolled in the Chicago Health and Aging Project. Among those, 71% were hospitalized at least once during the study. Researchers administered tests of memory and thinking skills every three years, making an overall measure of cognition skill based on the total of the four scores.
The rate of decline after hospitalization would be "equivalent to being more than 10 years older," Wilson said. The research, published in Neurology, was funded by the National Institutes of Health and National Institute on Aging.
"The hospital can be a bad place to go if you're an older individual," says physician Marie Bernard, deputy director of the National Institute on Aging. . "It should be avoided if possible, but that doesn't mean patients shouldn't see their health care provider. They need to do that."
Other findings:
• The rate of decline was three times faster on long-term memory tests after the first hospitalization and 1.5 times faster on a complex attention test.
• More severe illness, longer hospital stay and older age were associated with even faster cognitive decline after hospitalization.
Hospitals need to change how they care for the elderly, says Barbara Resnick, president of the American Geriatrics Society and professor of nursing at the University of Maryland School of Medicine. She says patients spend too much time in bed — alone and attached to monitors — instead of getting up, being encouraged to exercise or sit in a chair and have contact with others, behaviors that motivate patients to stay strong.
"Are we surprised at these findings? No," she says. "You see this a lot. The focus of acute care is taking care of the medical problem and not the care of the elderly down the road. Cognitive function is the last thing to be considered."
Wilson says a small group of participants did not show decline; he adds that additional studies need to be done to explain why certain elderly patients are more resilient.
"What we showed is that once you get out of the hospital your trajectory is downhill," he says. "In general, once people start declining they tend not to improve."
There is now a concentrated effort by Medicare to reduce re- hospitalizations of elderly people. Currently over 20% of Medicare folks are re hospitalized within 30 days of admission. Of course the best way to avoid re-hospitalizations is to prevent hospitalization in the first place.
At Always There Home Care we take a proactive approach to preventing hospitalization in elderly people. We work closely with Medicare home care agencies, physicians and families to monitor our clients with chronic disease and take all measures to prevent complications that may send them to the hospital. This includes monitoring weight, medication compliance, and exercise. physical
Therapy, home safety precautions, and regular checks on vital signs diet, fluid intake and even pulse oximetry. Our experience with keeping our clients out of the hospital is excellent and far below the national average for Medicare beneficiaries. Everyone… clients, families and caregivers are happier when our clients remain medically stable and stay at home!