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Cognitive Decline linked to Non-Elective Hospitalizations

By Jennifer Thew RN  
   July 19, 2017

Older adults who experienced emergency and urgent hospital admissions showed a 60% acceleration in the rate of cognitive decline.  

Emergency and urgent hospitalizations are associated with an increased rate of cognitive decline in older adults, finds a study of participants in the Rush Memory and Aging Project at Rush University Medical Center in Chicago.

The study suggests hospitalization may be a greater risk factor for long-term cognitive decline in older adults than previously recognized, say the project’s researchers.

“We found that those who have non-elective hospitalizations and who have not previously been diagnosed with dementia or Alzheimer’s disease had a rapid decline in cognitive function compared to the prehospital rates,” Bryan James, PhD says in a news release. “By comparison, people who were never hospitalized and those who had elective hospitalizations did not experience the drastic decline in cognitive function.”

James, an epidemiologist and in the Rush Alzheimer’s Disease Center and an assistant professor in the Rush Department of Internal Medicine, and his colleagues presented their findings at the Alzheimer’s Association International Conference in London on July 17.

Non-Elective Admissions and Cognitive Decline

The study of 930 older adults involved annual cognitive assessments and clinical evaluations. Hospitalization data was assessed by linking participants’ records of 1999 to 2010 Medicare claims with their MAP data. All hospital admissions were designated as elective or non-elective (this category consisted of emergency or urgent admissions).

Over an average of almost five years of observation, 613 of 930 participants were hospitalized at least once. Of those hospitalized, 260 (28%) had at least one elective hospital admission, and 553 (60%) had at least one non-elective hospital admission. These groups included 200 participants (22%) who had both types of hospitalizations.

While elective hospitalizations, were not associated with acceleration in the rate of cognitive decline, non-elective hospitalizations were associated with an approximately 60% acceleration in the rate of cognitive decline from before hospitalization.

“We saw a clear distinction: Nonelective admissions drive the association between hospitalization and long-term changes in cognitive function in later life, while elective admissions do not necessarily carry the same risk of negative cognitive outcomes,” says James.  “These findings have important implications for the medical decision making and care of older adults. While recognizing that all medical procedures carry some degree of risk, this study implies that planned hospital encounters may not be as dangerous to the cognitive health of older persons as emergency or urgent situations.”

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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