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Hospitalization Associated with Mental Decline

Spending time in today’s hospitals can have many downsides.

Although it seems counterintuitive, hospitalizations are linked to a host of medical errors and unintended consequences, including nosocomial (hospital-acquired) infection and, as discovered by new research, acute cognitive decline.

A paper in the current issue of JAMA reviews how older patients hospitalized for acute care or a critical illness are more likely to experience cognitive decline compared to older adults who are not hospitalized.

A large proportion of patients who are hospitalized for acute care or care of a critical illness are older adults. Some studies have suggested that many survivors of critical illness experience long-term cognitive impairment, but these studies did not measure cognitive function before a critical illness, according to background information in the article.

William J. Ehlenbach, M.D., M.Sc., of the University of Washington, Seattle, and colleagues analyzed data from a study that was conducting cognitive testing on older adults, and examined administrative data from hospitalizations to determine whether hospitalizations for acute illness or critical illness were associated with cognitive decline and dementia.

The study included data from 1994 through 2007 on 2,929 individuals, 65 years old and older without dementia at the beginning of the study. Cognition was measured with the Cognitive Abilities Screening Instrument (CASI) every 2 years at follow-up visits, and those with scores below a certain point underwent a clinical examination for dementia.

During an average follow-up of 6.1 years, 1,601 participants had no hospitalizations while enrolled in the study; 1,287 study participants were hospitalized for noncritical illness; and 41 participants were hospitalized for a critical illness.

There were 146 cases of dementia among those never hospitalized during the study. Among those experiencing 1 or more noncritical illness hospitalizations but no critical illness hospitalizations during study participation, there were 228 cases of dementia.

There were 5 cases of dementia among those experiencing 1 or more critical illness hospitalizations during the study.

The researchers found that patients who had a hospitalization for an acute care or critical illness had lower CASI scores at followup compared to those who were not hospitalized. Also, after adjusting for various factors, patients hospitalized for a noncritical illness had a 40 percent higher risk of dementia.

Patients hospitalized for a critical illness also had a higher risk of dementia, but the result was not significant, possibly because of the small number of participants in this group.

“The mechanism of this association is uncertain. Hospitalization may be a marker for cognitive decline or dementia that has not been diagnosed,” the authors write.

“These results also could suggest that factors associated with acute illness, and to a greater degree with critical illness, may be causally related to cognitive decline.”

The researchers add that the mechanisms through which critical illness may contribute to neurocognitive impairment are multiple, with evidence suggesting that hypoxemia (decreased partial pressure of oxygen in blood), delirium, hypotension, glucose dysregulation, systemic inflammation, and sedative and analgesic medications all may potentially play a role.

“Further studies are needed to better understand the factors associated with acute and critical illness that may contribute to cognitive impairment,” the authors conclude.

Source: JAMA and Archives Journals

Hospitalization Associated with Mental Decline

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2015). Hospitalization Associated with Mental Decline. Psych Central. Retrieved on July 16, 2018, from https://psychcentral.com/news/2010/02/25/hospitalization-associated-with-mental-decline/11707.html

 

Scientifically Reviewed
Last updated: 6 Oct 2015
Last reviewed: By John M. Grohol, Psy.D. on 6 Oct 2015
Published on PsychCentral.com. All rights reserved.