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资金来源：PAS-11-281（R21 NIA）本研究的目的是调查与住院前基线相比的医院相关认知障碍，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的可预防的医院相关的医院相关的认知障碍的危险因素。医疗保险每年花费14亿美元，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（K23 AG 028439 PI：Lindquist），许多老年人在出院时存在未被怀疑的认知障碍。这种认知功能的缺乏对理解和回忆出院指示构成了威胁，这可能会影响再住院。在接下来的一个月内，医院相关的认知障碍逐渐改善，这表明住院期间的可逆性下降。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功能障碍，以及认知功能在接下来的一个月内何时恢复。本研究的目的是：目的1：调查与住院前基线认知相比，出院时有认知障碍的社区居住老年人的百分比。目的2：确定与医院相关认知损害相关的受试者特征和医院事件。(e.g.停留时间， ICU转移，夜间醒来进行测试，使用镇静药物）。目标3：确定在出院后第2、7、18和30天，患有医院获得性可恢复的认知功能障碍的老年人恢复到基线认知功能的比例。目标4：确定与可恢复性认知功能障碍的认知恢复延迟率相关的受试者特征和医院事件。我们有一组1430名老年人的基线认知和心理社会数据，这些老年人目前要么参加了R 01 AG 03611，LITCOG（PI：Wolf），要么在老年病门诊接受治疗。我们将从这个队列中招募受试者， 住院超过21个月。我们计划连续评估300名住院老年人出院当天和出院后第2、7、18、30天的认知功能。调查将在住院期间亲自进行，并在出院后通过电话进行。我们还将从与患者特征和医院事件有关的医疗图表摘要中收集数据。医院相关的认知损害和认知恢复时间将是关注的结局。这项研究的结果将通过提供有关哪些可避免的事件导致医院获得性认知功能障碍和延迟认知恢复的信息，对老年人的医院护理产生潜在影响。 公共卫生相关性：许多住院老年人经历医院相关的认知障碍，这可能会影响对出院指示和再住院的理解。再住院已被确定为美国医疗保健系统中的一个重要问题，无论是对患者还是相关的医疗保健成本上升。我们需要更多地了解老年人在出院时所经历的认知变化。对认知产生不利影响的因素可以被识别并可能被预防，从而改善住院老年人的护理。

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.