Emergency Hospitalizations Linked to Faster Cognitive Decline

Emergency and urgent hospitalizations are a major factor in increased cognitive decline in older adults, claims a new study.

Researchers at Rush University Medical Center (Rush; Chicago, IL, USA), Vanderbilt University Medical Center (VUMC; Nashville, TN, USA), and other institutions conducted a prospective cohort study of community-dwelling older persons without baseline dementia in order determine if non-elective hospitalizations are associated with faster acceleration of cognitive decline, when compared to elective hospitalizations. For the study, annual measures of cognition in 777 participants (81 years old on average, 75% women) were linked to 1999-2010 Medicare claims records.

The results revealed that 59.2% of the patients were hospitalized, with 28.6% undergoing at least one elective and 53.8% at least one non-elective hospitalization. While those who were not hospitalized had a mean loss of 0.051 unit global cognition per year, there was no significant difference in rate of decline before or after elective hospitalizations. In contrast, decline before non-elective hospitalization was faster and accelerated, reflecting a mean loss of 0.112 global cognition units per year, more than double the rate of those not hospitalized. The study was published on January 11, 2019, in Neurology.

"We found that those who have non-elective (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,” said lead author epidemiologist Bryan James, PhD, of the Rush Alzheimer's Disease Center. “By comparison, people who were never hospitalized and those who had elective hospitalizations did not experience the drastic decline in cognitive function.”

“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,” concluded Dr. James, reiterating that, “non-elective admissions drive the association between hospitalization and long-term changes in cognitive function in later life. These findings have important implications for the medical decision making and care of older adults.”

Dementia is an overall term for the wide range of symptoms associated with a decline in memory or other cognitive skills severe enough to reduce a person's ability to perform everyday activities. The incidence of dementia is growing globally, with a new patient being diagnosed approximately every seven seconds. It is estimated that by 2050 there will be 11-19 million people in the USA alone living with dementia, of which Alzheimer’s disease, a progressive condition, is the most common form.

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