Cognitive decline after elective and nonelective hospitalizations in older adults
Open accessAbstract
Objective To determine whether emergent and urgent (nonelective) hospitalizations are associated with faster acceleration of cognitive decline compared to elective hospitalizations, accounting for prehospital decline. Methods Data came from the Rush Memory and Aging Project, a prospective cohort study of community-dwelling older persons without baseline dementia. Annual measures of cognition via a battery of 19 tests were linked to 1999 to 2010 Medicare claims records. Results Of 777 participants, 460 (59.2%) were hospitalized over a mean of 5.0 (SD = 2.6) years; 222 (28.6%) had at least one elective and 418 (53.8%) at least one nonelective hospitalization. Mixed-effects regression models estimated change in global cognition before and after each type of hospitalization compared to no hospitalization, adjusted for age, sex, education, medical conditions, length of stay, surgery, intensive care unit, and comorbidities. Persons who were not hospitalized had a mean loss of 0.051 unit global cognition per year. In comparison, there was no significant difference in rate of decline before (0.044 unit per year) or after (0.048 unit per year) elective hospitalizations. In contrast, decline before nonelective hospitalization was faster (0.076 unit per year; estimate = −0.024, SE = 0.011, p = 0.032), and accelerated by 0.036 unit (SE = 0.005, p < 0.001) to mean loss of 0.112 unit per year after nonelective hospitalizations, more than doubling the rate in those not hospitalized. Conclusions Nonelective hospitalizations are related to more dramatic acceleration in cognitive decline compared to elective hospitalizations, even after accounting for prehospital decline. These findings may inform which hospital admissions pose the greatest risk to the cognitive health of older adults.
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A growing body of evidence suggests that critical illness and medical encounters such as hospitalization in older people increase their risk of long-term cognitive impairment and dementia.
“A growing body of evidence suggests that critical illness and medical encounters such as hospitalization in older people increase their risk of long‐term cognitive impairment and dementia.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [224]
High-quality care for people with dementia takes longer than caring for others with the same condition.
“High-quality care for people with dementia takes longer than caring for others with the same condition.278”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [278]
The Participants section says people with dementia were removed from the analytic sample, and the Discussion addresses cognitive decline after hospitalization. Neither addresses how long high-quality care takes for people with dementia compared with others with the same condition. Searches for the claim’s wording and for comparative care time found no supporting passage; page numbers were not provided in our copy. (LLM, conf=0.76)
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Dementia prevention, intervention, and care: 2020 report of the Lancet Commission
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30367-6 · Cited by 10,430 · see citing works
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Retracted2023 Alzheimer's disease facts and figures
(2023) · Alzheimer's & Dementia · doi:10.1002/alz.13016 · Cited by 3,212 · see citing works
2024 Alzheimer's disease facts and figures
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- Authors
- James, B. D., Wilson, R. S., Capuano, A. W., Boyle, P. A., Shah, R. C., Lamar, M., Ely, E. W., Bennett, D. A., & Schneider, J. A.
- Affiliations
- Rush University Medical Center (US)
- ORCID
- Venue
- Neurology
- Published
- 2019-02-12
- Volume
- 92
- Issue
- 7
- Pages
- e690-e699
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC6382369
- OpenAlex
- W2910456407
- Cited by
- 36
- References
- 31
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 3 · 2020: 6 · 2019: 2
- FWCI
- 3.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (R01AG017917, K01AG050823, P30AG010161, R01AG033678, R01AG034374)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- cognitive decline, elective hospitalization, emergency admissions, older adults, global cognition, Medicare claims data
- MeSH terms
- Mental Status and Dementia Tests, Aged, Aged, 80 and over, Emergencies, Female, Medicare, Hospitalization, Humans, Male, Prospective Studies, United States, Cohort Studies, Independent Living, Cognitive Dysfunction
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