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Hospitalization Linked to Cognitive Decline in the Elderly

Dana Larsen
By Dana LarsenApril 3, 2012

The journal Neurology recently published new research linking the hospitalization of older people to accelerated cognitive decline. In many instances, these hospital stays are not necessary.

The Center for Medicare and Medicaid Services (CMS) is working on passing initiatives that reduce hospitalization and treat elderly patients outside the hospital setting, when feasible. Learn more.

Cognitive Decline in the Elderly

Many seniors fear hospital stays — and for good reason. Elderly patients who are hospitalized increase their risk of cognitive decline, according to a new study by journal Neurology.

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According to lead researcher Robert Wilson, rate of decline after hospitalization would be equivalent to being more than 10 years older, a scary statistic. “Because late life loss of cognitive function is a substantial and growing public health problem, understanding its link to an event as common as hospitalization is extremely important,” said researcher Wilson.

As the the aging baby boomer population begins to reach the 65+ age in record numbers, developing strategies to reduce or prevent these unnecessary hospitalizations is crucial.

Rate of Senior Cognitive Decline More Than Doubles After a Hospital Stay

The journal Neurology study indicates that seniors rate of cognitive decline more than doubles after a hospital stay. Since the exact cause of this decline is unknown, and is a bit perplexing, more research needs to be conducted. In many instances, however, the patient’s illness in conjunction with the treatments the patients’ receive at the hospital are shown to be contributing factors. But the many variables are misleading. For example, perhaps some of the patients are exposed to other illnesses in the hospital? Or perhaps the clinical setting for a period of time had a psychological impact on the elderly patients’ well-being? There are many hypotheses as to a possible decline.

“We think that a hospital stay can help unmask and accelerate previously unidentified cognitive problems,” Dr. Wilson comments. The research suggests that, once the decline starts, it’s rapid. And since daily activities — such as bathing, dressing and toileting — are interrupted, the brain starts to function differently. Dr. Malaz Boustani, Associate Professor of Medicine at Indiana University, also has a theory. He suspects the culprit is delirium; or the abrupt changes that make the elderly patients disoriented, confused unresponsive and withdrawn. According to the doctor, delirium can “change the trajectory of your cognitive status… Even when you supposedly recover, there’s a residual effect,” he finds.

Finding a “Hospitable” and Healthy Solution

Some of these hospital stays are not necessary and are not only contributing to seniors’ decline, but are also costing unnecessary dollars. “Several studies suggest that many of these hospitalizations are inappropriate, avoidable, or related to conditions that could be treated outside the hospital setting — and they cost more than $4 billion per year,” said journal Neurology research authors, Joseph Ouslander and Robert Berensen. Some of the main culprits are avoidable hospitalizations that are common among long-stay residents of nursing homes.

This is where knowledge is power. Now that the research has been conducted and published, families and organizations have become aware. In fact, The Center for Medicaid and Medicare Services (CMS) recently announced a timely initiative to help solve for this senior hospitalization debacle. The new initiative aims to reduce hospitalization from skilled nursing facilities by funding organizations to partner with the nursing facilities to provide “enhanced on-site services and support” to the elderly. And luckily they’re beginning to see traction. Apparently, 23 new organizations are participating in CMS’ Community-based Care Transitions Program (CCTP) to partner with health care and social service providers, as well as, hospitals and skilled nursing facilities to support Medicare patients — some of the most at-risk for hospitalization.

Finding the delicate balance of treating seniors outside of the hospital, when appropriate, with effectively treating elderly patients in the hospital — knowing some of the consequences, can be tricky. Initiatives and public knowledge are the first step to helping the aging population maintain their quality of life.

Has your family had experience with senior hospitalization? Share your family’s story with us in the comments below.

Dana Larsen
Dana Larsen
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