Hospital Discharge and Cognitive Changes in Older Adults

描述（由申请人提供）：老年人的出院和认知变化PI: Lindquist资助来源：PAS-11-281 （R21 NIA）本研究的目的是调查与住院前基线相比的住院相关认知障碍，并确定出院后一个月内认知恢复的时间。我们还将检查患者和潜在可预防的医院相关认知障碍的危险因素。每年花费14亿美元的医疗保险，五分之一的老年人在出院后30天内再次住院。我们之前发现，（K23AG028439 PI: Lindquist），许多老年人，在出院时，有未被怀疑的认知障碍。这种认知功能的缺乏对出院指示的理解和回忆构成威胁，可能影响再住院。在接下来的一个月里，医院相关的认知障碍逐渐改善，这表明住院期间的下降是可逆的。目前还没有研究调查哪些医院因素会影响医院相关的认知障碍，以及在接下来的一个月里认知恢复的时间。本研究的目的是：目的1：调查社区居住的老年人在出院时有认知障碍的百分比，与住院前的基线认知相比。目的2：确定与医院相关认知障碍相关的受试者特征和医院事件。(例如逗留时间；

DESCRIPTION (provided by applicant): Hospital Discharge and Cognitive Changes in Older Adults PI: Lindquist Funding Source: PAS-11-281 (R21 NIA) The objectives of this study are to investigate hospital-associated cognitive impairment when compared to a pre-hospitalization baseline and to determine when cognitive recovery occurs in the month following hospital discharge. We will also examine patient and potentially preventable hospital- related risk factors of hospital-associated cognitive impairment. Costing Medicare $1.4 Billion annually, 1/5th of seniors are re-hospitalized within 30 days of hospital discharge. We have previously found, (K23AG028439 PI: Lindquist), that many elderly, at the time of hospital discharge, have unsuspected cognitive impairment. This lack of cognitive function poses a threat to comprehension and recall of discharge instructions which may impact rehospitalizations. The hospital-associated cognitive impairment gradually improves over the next month which suggests a reversible decline during the hospitalization. No studies yet have examined what hospital factors impact hospital-associated cognitive impairment and when cognitive recovery occurs in the month following. The aims of this study are to: Aim 1: Investigate the percentage of community-dwelling older adults who have cognitive impairment at hospital discharge when compared to pre- hospitalization baseline cognition. Aim 2: Identify subject characteristics and hospital events that correlate with hospital-associated cognitive impairment. (e.g. length of stay, ICU transfers, nighttime awakenings for tests, sedating medication use). Aim 3: Determine the proportion of older adults with hospital-acquired recoverable cognitive dysfunction who return to baseline cognitive function at post-hospital discharge days 2, 7, 18, and 30. Aim 4: Identify subject characteristics and hospital events that correlate with delayed rate of cognitive recovery in recoverable cognitive dysfunction. We have baseline cognitive and psychosocial data on a cohort of 1430 older adults who either are currently enrolled in R01AG03611, LITCOG (PI: Wolf) or receive care in geriatrics outpatient clinics. We will recruit subjects from this cohort who are hospitalized over a 21 month period. We plan to serially assess cognitive function on day of discharge, and post-discharge days 2, 7, 18, 30 for 300 hospitalized older adults. Surveys will be conducted in person while hospitalized, and by telephone following discharge. We will also collect data from medical chart abstraction pertaining to patient characteristics and hospital events. Hospital-associated cognitive impairment and time of cognitive recovery will be the outcomes of interest. Results from this study will potentially impact the hospital care of seniors by providing information on what avoidable events cause hospital-acquired cognitive dysfunction and delay cognitive recovery. PUBLIC HEALTH RELEVANCE: Many hospitalized seniors experience hospital-associated cognitive impairment which may impact understanding of discharge instructions and rehospitalizations. Rehospitalizations have been identified as a significant problem in the American health care system, both to patients and to the associated rising health care costs. We need to understand more about the cognitive changes that seniors experience at hospital discharge. Factors that adversely affect cognition can be identified and potentially prevented, thus improving the care of hospitalized seniors.