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Cognitive impairment may be more likely in patients who survive sepsis
Iwashyna T. JAMA. 2010; 304:1787-1794.
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Older adults who survive severe sepsis are at higher risk for long-term cognitive impairment and physical limitations compared with those who are hospitalized for other reasons, according to a study recently published in the Journal of the American Medical Association.
Investigators from the University of Michigan Health System found that 60% of hospitalizations for severe sepsis were associated with worsened cognitive and physical function among surviving older adults, with the odds of acquiring “moderate to severe cognitive impairment” being 3.3 times higher following an episode of sepsis than for other hospitalizations.
“We used to think of sepsis as just a medical emergency, an infection that you get sick with and then recover,” Theodore Iwashyna, MD, PhD, assistant professor of internal medicine at University of Michigan Medical School, stated in a university press release. “But, we discovered a significant number of people face years of problems afterwards.”
Significant impairments
The researchers used data from the National Institute on Aging (NIA)-supported Health and Retirement Study, a long-term study that collects information on the health, economic and social factors influencing the health and well-being of a nationally representative sample of Americans older than 50 years.
Among patients who had no limitations before sepsis, the researchers found that more than 40% developed trouble with walking. Additionally, nearly 20% developed new problems with shopping or preparing a meal. Patients often developed new problems with basic tasks, such as bathing and toileting themselves.
“These problems are bigger and more common than we expected,” Iwashyna stated in the release. “Most older Americans suffer real brain and body problems. We need new treatments, not just for the sepsis infection, but to prevent these new disabilities afterwards.”
Proper preparation
The researchers noted that the research underscores a need for physicians to focus early on preventing infections that can lead to sepsis in older patients. This includes making sure older patients receive their influenza and pneumonia vaccinations, as well as ensuring that physicians are aware of the long-term risk for cognitive and physical disabilities that many patients may face.
“This is an underrecognized public health problem with major implications for patients, families and the health care system,” Iwashyna stated in the release, adding that the health care system must make sure families have the resources necessary to care for survivors of sepsis who are returning home.
“We need to start preparing them for the years of problems they may have afterwards,” he noted.
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