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Nonelective hospitalizations may accelerate cognitive decline in older adults

Although elective hospitalizations were not significantly related to a decline in cognitive function among older adults, emergency hospitalizations were associated with a rapid acceleration in cognitive decline, according to data presented at the 2017 Alzheimer’s Association International Conference.

“We found that those who have nonelective (emergency or urgent) 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 D. James, PhD, assistant professor in the department of internal medicine at Rush University Medical Center and epidemiologist with the Rush Alzheimer’s Disease Center, said in a press release. “By comparison, people who were never hospitalized and those who had elective hospitalizations did not experience the drastic decline in cognitive function.”

James and colleagues analyzed whether elective hospitalizations are linked to a decreased rate of cognitive decline among older compared with nonelective hospitalizations. Researchers used data from the Rush Memory and Aging Project to examine the annual cognitive assessments of 930 older adults, linking the assessments to more than a decade of Medicare claims records. The investigators then categorized all hospital admissions as elective, emergency or urgent.

Analysis showed that 613 participants were hospitalized at least once over an average of 4.8 years of observation. Of these, 260 (28%) had at least one elective hospital admission, 553 (59.5%) had at least one nonelective hospital admission, and 200 (21.5%) had both elective and nonelective hospitalizations.

Compared with no hospitalization, the rate of cognitive decline accelerated after elective hospitalizations (estimate = –0.025; P < .001), and the increase was almost twice as rapid after nonelective hospitalizations (estimate = –0.043; P < .001). Nonelective hospitalizations were associated with faster cognitive decline (estimate = –0.042; P < .001), but the association for elective hospitalizations was not statistically significant.

“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,” James said in the release. “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.” – by Savannah Demko

References:

James BD, et al. Abstract a17960. Presented at: Alzheimer's Association International Conference; July 16-20, 2017; London.

Disclosures: Healio Internal Medicine was unable to confirm the researchers’ relevant financial disclosures at the time of publication.