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 Funding来源：PAS-11-281(R21 NIA)这项研究的目的是调查与住院前基线相比较的与医院相关的认知障碍，并确定在出院后的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。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。我们之前已经发现(K23AG028439 PI：Lindquist)，许多老年人在出院时有意外的认知障碍。这种认知功能的缺乏对出院指示的理解和回忆构成了威胁，这可能会影响再次住院。医院相关的认知障碍在接下来的一个月里逐渐改善，这表明在住院期间出现了可逆的下降。目前还没有研究检查哪些医院因素会影响医院相关的认知障碍，以及认知能力在接下来的一个月里何时会恢复。这项研究的目的是：目的1：调查社区老年人在出院时与入院前基线认知相比有认知障碍的百分比。目标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、 ICU转院，夜间醒来进行检查，镇静药物使用)。目的3：确定有医院获得性可恢复性认知功能障碍的老年人在出院后第2、7、18和30天恢复到基线认知功能的比例。目的4：确定与可恢复性认知功能障碍患者认知功能恢复延迟相关的受试者特征和医院事件。我们有1430名老年人的基线认知和心理社会数据，他们要么目前参加了R01AG03611，LITCOG(PI：WOLF)，要么在老年病门诊接受护理。我们将从这个队列中招募符合以下条件的受试者 住院时间超过21个月。我们计划对300名住院老年人在出院当天、出院后第2天、第7天、第18天、第30天的认知功能进行连续评估。调查将在住院期间亲自进行，出院后通过电话进行。我们还将从与患者特征和医院事件相关的病历摘要中收集数据。与医院相关的认知障碍和认知恢复时间将是令人感兴趣的结果。这项研究的结果将潜在地影响老年人的医院护理，因为它提供了关于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。

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.