Association of Hospitalization with Long‐Term Cognitive Trajectories in Older Adults

Šprung, Juraj; Knopman, David S.; Petersen, Ronald C.; Mielke, Michelle M.; Weingarten, Toby N.; Vassilaki, Maria; Martin, David P.; Schulte, Phillip J.; Hanson, Andrew C.; Schroeder, Darrell R.; Laporta, Mariana L.; White, Robert J.; Vemuri, Prashanthi; Warner, David O.

doi:10.1111/jgs.16909

Cited by 27 publications

(23 citation statements)

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“…As opposed to Sprung et al . [ 2 ] our study found that number of hospitalisations was not associated with cognitive decline . We additionally found that although the participants with delirium spent more days in hospital during the 1 year study period, total duration of hospital stay was not associated with cognitive decline in our models.…”

Section: Discussionmentioning

confidence: 60%

“…In a number of large studies, acute hospitalisation has been shown to be adversely associated with increased risks of incident dementia and accelerated trajectories of cognitive decline [ 1–6 ]. The components driving these associations are unclear but factors demonstrated to confer increased risk of worse cognitive outcomes following hospitalisation include non-elective admission [ 1 , 2 ], critical illness [ 3 , 4 ], admissions for medical conditions [ 2 ] and stroke [ 5 ], longer admissions [ 4 ] along with a number of baseline comorbidities [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Hospitalisation without delirium is not associated with cognitive decline in a population-based sample of older people—results from a nested, longitudinal cohort study

et al. 2021

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Background Acute hospitalisation and delirium have individually been shown to adversely affect trajectories of cognitive decline but have not previously been considered together. This work aimed to explore the impact on cognition of hospital admission with and without delirium, compared to a control group with no hospital admissions. Methods The Delirium and Cognitive Impact in Dementia (DECIDE) study was nested within the Cognitive Function and Ageing Study II (CFAS II)–Newcastle cohort. CFAS II participants completed two baseline interviews, including the Mini-Mental State Examination (MMSE). During 2016, surviving participants from CFAS II–Newcastle were recruited to DECIDE on admission to hospital. Participants were reviewed daily to determine delirium status. During 2017, all DECIDE participants and age, sex and years of education matched controls without hospital admissions during 2016 were invited to repeat the CFAS II interview. Delirium was excluded in the control group using the Informant Assessment of Geriatric Delirium Scale (i-AGeD). Linear mixed effects modelling determined predictors of cognitive decline. Results During 2016, 82 of 205 (40%) DECIDE participants had at least one episode of delirium. At 1 year, 135 of 205 hospitalised participants completed an interview along with 100 controls. No controls experienced delirium (i-AGeD>4). Delirium was associated with a faster rate of cognitive decline compared to those without delirium (β = −2.2, P < 0.001), but number of hospital admissions was not (P = 0.447). Conclusions These results suggest that delirium during hospitalisation rather than hospitalisation per se is a risk factor for future cognitive decline, emphasising the need for dementia prevention studies that focus on delirium intervention.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Hospitalisation without delirium is not associated with cognitive decline in a population-based sample of older people—results from a nested, longitudinal cohort study

et al. 2021

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“…In addition, a growing body of evidence indicates that critical illness and medical encounters such as hospitalization in older people increase their risk of long‐term cognitive impairment 189–195 . The emergence of novel coronavirus disease in 2019 (COVID‐19) has resulted in tens of thousands of hospitalizations.…”

Section: Overview Of Alzheimer's Diseasementioning

confidence: 99%

2021 Alzheimer's disease facts and figures

2021

Alzheimer's & Dementia

1,877

849

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth‐leading cause of death in the United States and the fifth‐leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID‐19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes — costs that have been aggravated by COVID‐19. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain — both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID‐19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.

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“…A growing body of evidence indicates that critical illness and medical encounters such as hospitalization in older people increase their risk of long-term cognitive impairment. [200][201][202][203][204][205][206] The emergence of novel coronavirus disease in 2019 (COVID-19) resulted in more than 1.3 million hospitalizations among U.S. adults age 65 and older between January 1, 2020, and July 24, 2021. 207 This has the potential to increase the number of cases of cognitive impairment following critical illness.…”

Section: Other Risk Factorsmentioning

confidence: 99%

2022 Alzheimer's disease facts and figures

2022

Alzheimer's & Dementia

1,571

664

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes -costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI 700

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Association of Hospitalization with Long‐Term Cognitive Trajectories in Older Adults

Cited by 27 publications

References 41 publications

Hospitalisation without delirium is not associated with cognitive decline in a population-based sample of older people—results from a nested, longitudinal cohort study

Hospitalisation without delirium is not associated with cognitive decline in a population-based sample of older people—results from a nested, longitudinal cohort study

2021 Alzheimer's disease facts and figures

2022 Alzheimer's disease facts and figures

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