Emergency and urgent admissions are associated with an increase in cognitive decline in the elderly, according to researchers at Rush University Medical Center. Results of their study, published in January 11, 2019, online number of Neurology, the medical journal of the American Academy of Neurology, shows that hospitalization may be a major risk factor for long-term cognitive decline in the elderly compared to that previously recognized.
"We found that those who have non-elective (emergency or urgent) hospitalizations and who have not been previously diagnosed with dementia or Alzheimer's disease have had a rapid decline in cognitive function (ie thinking ability) compared to pre-hospital rates," said Bryan James, PhD, an epidemiologist and in the Rush Alzheimer's Disease Center and an assistant professor in the department of internal medicine Rush. "By comparison, people who have never been admitted to hospital and those who have had hospital admissions have not experienced the drastic decline in cognitive function".
In 2017, James and colleagues presented a preliminary version of their study results at the Alzheimer's Association International Conference in London.
The study compares hospitalization data and cognitive assessments for 777 seniors
Data emerged from a study of 777 elderly people (81 years on average, 75% of them women) enrolled in the Rush Memory and Aging (MAP) project in Chicago. The study involved annual cognitive assessments and clinical evaluations.
Information on admissions was acquired by linking the Medicare requests records from 1999 to 2010 for these participants with their MAP data. All hospital admissions were designated as elective, emergency or urgent. The last two were combined as non-electives for analysis.
Of the 777 participants, 460 were admitted at least once on an average of almost five years of observation. Of those who were hospitalized, 222 (29% of the total study population) had at least one elective hospitalization and 418 (54%) had at least one non-elective hospitalization. These groups included 180 participants (23 percent) who had both types of hospitalization.
Non-elective hospitalizations were associated with an acceleration of approximately 50 percent of the rate of cognitive decline before hospitalization, and a rate of cognitive decline that was more than twice the rate in people who were not hospitalized. Elective hospitalizations, however, were not at all associated with the acceleration of the rate of decline.
"Elective admissions do not necessarily entail the same risk"
"We have seen a clear distinction: non-elective admissions guide the association between hospitalization and long-term changes in cognitive function in old age, while elective admissions do not necessarily carry the same risk of negative cognitive outcomes," James said. . "These results have important implications for medical decision-making and care for the elderly.
"While recognizing that all medical procedures involve a certain degree of risk, this study implies that scheduled hospital meetings may not be hazardous to the cognitive health of older people such as emergency or urgent situations."
The reason why emergency and emergency hospitalizations are at greater risk of long-term cognitive decline than elective admissions is unknown, but may be due to differences in disease levels (although the authors are checked for health status ), stress or hospital procedures involved. The authors plan to explore these reasons in future research.
This work expands on previous research that has shown that after being admitted to hospital, the elderly are at high risk of memory and other cognitive problems, including transient delirium (temporary) and long-term changes in cognition, including dementia. According to the Healthcare cost and utilization project of October 2010, 40% of all hospitalized patients in the United States are 65 and over. Therefore, hospitalization may be an unrecognized risk factor for cognitive decline and dementia for a large number of older adults who deserve more attention.
The discovery of dementia in the very early stages has become a world priority, because pharmacological treatments, prevention strategies and other interventions will probably be more effective very early in the disease process, before extensive brain damage has occurred.