Cognitive decline in high-functioning older persons is associated with an increased risk of hospitalization
Cognitive decline in high-functioning older persons is associated with an increased risk of hospitalization
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DOI：
10.1111/j.1532-5415.2004.52407.x
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发表时间：
2004-09-01
影响因子：
6.3
通讯作者：
Reuben, DB
中科院分区：
文献类型：
--
作者：
Chodosh, J;Seeman, TE;Reuben, DB
设计：将医疗保险A部分的医院利用数据与麦克阿瑟成功老龄化社区研究网络的数据联系起来，以检验基线认知和3年内认知功能下降与同期住院之间的关系。地点：康涅狄格州纽黑文和马萨诸塞州东波士顿。参与者：受试者(N=598)来自麦克阿瑟成功老龄化社区研究网络的两个站点，一项为期7年的社区老年人高生理和认知功能的队列研究。测量：采用多元Logistic回归分析确定住院3年以上(1988-91年)作为结果变量，基线认知功能和3年以上认知功能下降作为主要预测变量之间的关联。结果：在598名受试者中，48人在1988年至1991年间死亡。没有基线(1988年)、延迟回忆分数或回忆分数的变化(1988-91年)与住院有关。尽管48.2%的人在言语记忆得分上有所下降，但下降与住院风险无关。在494名拥有完整3年数据的受试者中，31.2%的受试者在SPMSQ上下降了至少一分，4.7%的受试者下降了两分以上。在基线年龄在75岁及以上的人中，与下降较少者相比，下降超过2分的老年人住院的调整后优势比为7.8(95%可信区间=2.0-30.8)。结论：尽管特定的记忆测试与住院无关，但总体认知功能下降的高功能老年人更有可能住院治疗。在这个高功能队列中，基线认知功能的变化不会影响住院治疗，但需要进一步的研究来评估与其他医疗费用的相关性。
Objectives: To examine hospital use for patients with evidence of cognitive decline indicative of early cognitive impairment.Design: Medicare Part A hospital utilization data were linked to data from the MacArthur Research Network on Successful Aging Community Study to examine the association between baseline cognition and decline in cognitive function over a 3-year period and any hospitalization over that same period.Setting: New Haven, Connecticut, and East Boston, Massachusetts.Participants: Subjects (N=598) were from two sites of the MacArthur Research Network on Successful Aging Community Study, a 7-year cohort study of community-dwelling older persons with high physical and cognitive functioning.Measurements: Multivariate logistic regression was used to determine the association between any hospitalization over 3 years (1988-91) as the outcome variable and baseline cognitive function and decline in cognition over 3 years as primary predictor variables. Decline was based upon repeated (1988 and 1991) measures of delayed verbal recall and the Short Portable Mental Status Questionnaire (SPMSQ).Results: Of 598 subjects, 48 died between 1988 and 1991. No baseline (1988) delayed recall scores or change in recall scores (1988-91) were associated with hospitalization. Although 48.2% declined on verbal memory scores, decline was not associated with risk of hospitalization. Of 494 subjects with complete 3-year data, 31.2% declined at least one point on the SPMSQ, and 4.7% declined more than two points. Among individuals aged 75 and older at baseline, the adjusted odds ratio for hospitalization for those who declined more than 2 points compared with those who declined less was 7.8 (95% confidence interval=2.0-30.8).Conclusion: Although specific memory tests were not associated with hospitalization, high-functioning older persons who experienced decline in overall cognitive function were more likely to be hospitalized. Variation in baseline cognitive function in this high-functioning cohort did not affect hospitalization, but additional research is needed to evaluate associations with other healthcare costs.