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Geriatric Patients Show Greater Cognitive Decline after Hospitalization


 

A new report that suggests cognitive function tends to decline substantially when older patients are admitted to the hospital could be an opportunity for hospitalists to be proactive in developing interventional therapies to combat the deterioration.

"Cognitive Decline after Hospitalization in a Community Population of Older Persons," published last month in Neurology, found that patients' global cognitive score declined a mean of 0.031 units per year before the first hospitalization, compared with 0.075 units per year thereafter, a more-than-twofold increase. Similar declines were seen in episodic memory (a 3.3-fold increase post-hospitalization) and executive function (a 1.7-fold increase post-hospitalization), according to the survey. More severe illness, longer hospital stay, and older age were associated with even faster cognitive decline after hospitalization.

David Likosky, MD, SFHM, a hospitalist and medical director of The Evergreen Neuroscience Institute in Kirkland, Wash., and a faculty member at HM12 last week in San Diego, says that more research could identify why cognitive functions decrease, as well as assist in developing techniques and therapies that could address the issue.

"A great next step would be to assess short-term cognitive changes post-hospitalization and [watch] how those evolve in the months that follow," Dr. Likosky tells The Hospitalist. "This has implications for discharge planning, and potentially for readmission risk. The step after that will be to determine what strategies might help prevent the cognitive decline seen in the study."

Such a process, he says, has a multiple advantages: First, it can help patients and their families prepare for possible scenarios; second, it provides opportunities for hospitalists to proactively address the issue of cognitive decline.

"If we as hospitalists can intervene to change this rate of decline," says Dr. Likosky, "we can make a great difference in patients' lives."

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