Hospital Discharge and Cognitive Changes in Older Adults

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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.