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Hospitalization may speed cognitive decline in seniors
March 21st, 2012
05:04 PM ET

Hospitalization may speed cognitive decline in seniors

People 65 years of age and older experience cognitive decline an average of 2.4 times faster if they have been hospitalized, compared to people of the same age who haven't, according to a new study.

For the study, published in Neurology, Robert S. Wilson, PhD. and colleagues reviewed the cognitive decline of more than 1,800 patients aged 65 and older who lived in Chicago. The patients were given a baseline cognitive test and then followed for an average of nine years with the same cognitive test repeated at least three times at intervals of three years.

They found that the natural cognitive decline people begin to experience as they age was sped up after a person had been hospitalized, regardless of the reason or how long the hospitalization lasted.

"We were expecting that there might be some effect but I didn't expect it to be this big, this broad," says Wilson, a professor of neurological sciences and behavioral sciences at Rush University Medical Center.

"[Their decline] had seemingly little to do with the illness that put them there in the first place. It's a very striking finding and somewhat worrisome."

Wilson points out that there is a degree of variability to the deterioration some patients may experience after being in the hospital, ranging from some individuals not seeing any change in their cognitive abilities to others declining rapidly.

"But as a population, they're doing a lot worse than they were before they went in to the hospital," says Wilson.

Why the decline varies from person to person or happens at all is still unknown. Although researchers and health care professionals have heard anecdotal evidence of this phenomenon for several years, no study has been able to identify the mechanism(s) behind it.

"That's the million dollar question," says Dr. Marie Bernard, the Deputy Director of the National Institute of Aging, who was not affiliated with the study.

"We know that older individuals in the hospital are at greater risk for developing delirium and we know that theoretically, delirium is a temporary phenomenon but reasearch shows it can last for several months. If that... leads to longer term change in cognitive abilities, we don't know."

Wilson and Bernard believe caregivers, family, and friends of people 65 and older should be aware that hospitalizations may cause a lapse in an older patient's cognitive abilities. There is no research to show definitively what steps could be taken to avoid that but Bernard believes that a close relationship with the patient's primary care doctor could help.

"It would seem reasonable that if you could avoid hospitalization, you could avoid any cognitive decline (from hospitalization)," says Bernard.

"When you see the development of new symptoms or causes for concern, contact [the patient's] primary care provider because if you're working closely with [them], you can avoid hospitalization."


soundoff (18 Responses)
  1. Al Pater

    I thought that the article above and the abstract should have mentioned that they corrected for the confounding variable of anestesia usage.

    http://www.neurology.org/content/early/2012/03/21/WNL.0b013e31824d5894.abstract?sid=d69b2df3-6fe3-4ea0-b2e4-378a6493905e

    March 21, 2012 at 19:57 | Report abuse | Reply
  2. pixilator

    Anesthesia, as well as narcotic pain meds. Also length of stay should also be considered. Hospitals are at full tilt all day and night. It is VERY easy to become disoriented in this environment.

    March 21, 2012 at 23:50 | Report abuse | Reply
  3. Janet

    Both my parent has Alzheimer's. Any hospitalization was a guarantee of a major cognitive decline. Personally, I think the total disruption to one's day, the lack of night or day, and the lack of control are the causative factors. I cringed any time either of them went into the hospital.

    March 22, 2012 at 00:02 | Report abuse | Reply
    • Janet

      Make that "parents had".

      March 22, 2012 at 00:02 | Report abuse |
    • Patricia Krulek

      I can the same situation with my dad, I agree with you wholeheartedly

      March 22, 2012 at 07:21 | Report abuse |
    • BigDawg

      I saw this exact situation with my mom. She was hospitalized for 3 days and what had been mild Alzheimer's degenerated to moderate in just a couple of weeks after the hospital stay. She was sedated for only one procedure but the entire experience seemed to trigger a rapid decline.

      March 24, 2012 at 01:01 | Report abuse |
  4. Karen

    My father was hospitalized two years ago at the age of 80 for a pacemaker insertion that went wrong. A nicked lung set off a series of other complications that required him to be hospitalized for 12 days. This was his first and only hospitalization (he was born at home). We noticed significant cognitive decline almost immediately after, but ascribed it to the trauma of the experience. Was it that, or something else? Glad to hear someone is taking a look at this.

    March 22, 2012 at 09:16 | Report abuse | Reply
  5. pixilator

    I realize that the article mentions length of stay, but they don't count it as a factor. I went through this to a lesser degree and I am in my 40'S. I would be glad to give information toward this study. Patients of all ages can have this occur, much to the patient's and their families dismay.

    March 22, 2012 at 10:47 | Report abuse | Reply
  6. Portland tony

    Strange study! Perhaps being hospitalized tends to increase the feeling of vulnerability. My feeling upon leaving from an unplanned visit was the increased motivation to stay the hell away from them. My perception is twp visits per lifetime is max. One entering the world and once leaving.

    March 22, 2012 at 11:01 | Report abuse | Reply
    • Minneapolis Man

      Who says you have to be so dependent upon the Medical system that you should be born and die in their care? My grandpa died in our house after 14 months of blood poisoning from the medical system cuz the over-radiated his intestines back in the 1980's. I don't want to spend 90% of my health care on the last six months of my life like most. I want to live without them deciding what 's best for me cuz they're inept to deal with the reality of life coming to an end. "Do no harm" has to take on a much broader sense to hand back these decisions most people handed off to them. Give people some choices AND include no further medical intervention. How sad when there is a DNR (Do Not Resescitate) order yet somebody graps the phone and dials up 911 instead of watching them draw their last breathe in peace while we are surrounding them!

      March 22, 2012 at 22:48 | Report abuse |
  7. Dragginbutt

    No mention of Drugs administered in Hospitals having any influence, nor the fact that you can't get any rest while you are there either. Getting woke up every coule hours for a needle stick here, a blood pressure check there leaves you in a constant doze off, wake up cycle that can take it's toll as well. After 5 days for a bypass last December I can attest to that. Great, now I have something else to worry about....

    March 22, 2012 at 12:28 | Report abuse | Reply
  8. choffma

    Another reason is that they are not getting the proper care and lay around all day. Sorry to say but I just experienced this with my 76 year old father who was never taken out of bed or washed up unless I demanded.

    March 22, 2012 at 14:05 | Report abuse | Reply
    • Anita

      My father with Alzheimer's spent the last 52 days of his life in 4 different hospitals. I totally agree with you. I had to chase down nurses just to clean him up. He went from bad to worse. It was heartbreaking watching him get worse and worse and not be able to do anything about it. It was a relief when he died, because he wasn't suffering any more.

      March 22, 2012 at 18:18 | Report abuse |
  9. drew

    People go to the hospital when they are ill. It is no surprise that you may see statistical changes. If the problem is serious enough to warrant admission likely serious enough to cause cognitive problems or exacerbate other cognitive problems. Could read like this "Study follows 50 people who visit ice cream shop regularly finds statistically have elevated A1c versus 50 who don't go to ice cream shop. " no surprise there.

    March 22, 2012 at 16:40 | Report abuse | Reply
  10. Jennifer

    It seems that hospitalization of an elderly person would, just by surroundings and the routines, have them become less mentally engaged and stimulated. Lets face it, hospitalization is usually long hours of very little activity, irregular sleep and basic disruption of normal life. Sadly, cognitive decline doesn't seem like a big surprise here.

    March 22, 2012 at 19:32 | Report abuse | Reply
  11. Sue

    I am wondering if there was any effort to factor in the effects of general anaesthesia. Perhaps it plays some sort of role?

    March 26, 2012 at 16:37 | Report abuse | Reply
  12. Bill A

    My younger sister went into the hospital with a possible stroke. It was not a stroke. She has aged about 5 years since her short stay. No interest in going to the state fair, eating out or doing much of anything fun. I think the aging came from too much medical advice to slow down – "you are too old to be doing X, Y, and Z". She was a wreck while in the hospital from the drugs they were giving her to the lack of sleep due to noise and getting woke up every few hours. The nursing staff would come in and adjust the bed angle while she was beginning to sleep further disturbing her. The sleeping pills they offered her only made things worse during the day.

    I look back when my great aunt at 95 had to be put in a elder care center due to Altheimer's beginning to set in. She was taking no medication when she went in and was fully able to walk with out assistance. The staff made strong suggestions to her that life would be easier for her if she would use a wheelchair. I think the suggestion was more for the convenience of the staff than anything else. Daytime was spent with the residents sitting semi-circle around a TV in the day room. Dinner was at 5:00 and one by one the residents were wheeled back to their rooms with their night clothes laid out on the bed. She lost long time interest in Baseball games, as she was missing the day games and got strong suggestions to go to bed after dinner and not watch TV (she had her own set).

    March 26, 2012 at 18:15 | Report abuse | Reply
  13. Denise, Colfax WA

    My dad told me many times that he put my mom in the hospital for pneumonia and she came out with Alzheimer"s!! I know she had mild symptoms prior to a weeks stay but he said it was a dramatic change. As she was driving still, then they had to take her car away shortly after her stay. We also had her in for a knee operation last year. My sister in law said she came out of the operation babbling for 3 days. So I think there is something going on here also!!

    March 26, 2012 at 18:47 | Report abuse | Reply

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