老年人择期和非择期住院后的认知能力下降。
Cognitive decline after elective and nonelective hospitalizations in older adults.
机构信息
From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.
出版信息
Neurology. 2019 Feb 12;92(7):e690-e699. doi: 10.1212/WNL.0000000000006918. Epub 2019 Jan 11.
OBJECTIVE
To determine whether emergent and urgent (nonelective) hospitalizations are associated with faster acceleration of cognitive decline compared to elective hospitalizations, accounting for prehospital decline.
METHODS
Data came from the Rush Memory and Aging Project, a prospective cohort study of community-dwelling older persons without baseline dementia. Annual measures of cognition via a battery of 19 tests were linked to 1999 to 2010 Medicare claims records.
RESULTS
Of 777 participants, 460 (59.2%) were hospitalized over a mean of 5.0 (SD = 2.6) years; 222 (28.6%) had at least one elective and 418 (53.8%) at least one nonelective hospitalization. Mixed-effects regression models estimated change in global cognition before and after each type of hospitalization compared to no hospitalization, adjusted for age, sex, education, medical conditions, length of stay, surgery, intensive care unit, and comorbidities. Persons who were not hospitalized had a mean loss of 0.051 unit global cognition per year. In comparison, there was no significant difference in rate of decline before (0.044 unit per year) or after (0.048 unit per year) elective hospitalizations. In contrast, decline before nonelective hospitalization was faster (0.076 unit per year; estimate = -0.024, SE = 0.011, = 0.032), and accelerated by 0.036 unit (SE = 0.005, < 0.001) to mean loss of 0.112 unit per year after nonelective hospitalizations, more than doubling the rate in those not hospitalized.
CONCLUSIONS
Nonelective hospitalizations are related to more dramatic acceleration in cognitive decline compared to elective hospitalizations, even after accounting for prehospital decline. These findings may inform which hospital admissions pose the greatest risk to the cognitive health of older adults.
目的
确定与选择性住院相比，紧急（非选择性）住院是否与认知能力下降的加速更快相关，同时考虑到住院前的下降。
方法
数据来自于 Rush 记忆与衰老项目，这是一项针对无基线痴呆的社区居住老年人的前瞻性队列研究。通过一套 19 项测试的年度认知测量结果与 1999 年至 2010 年的 Medicare 理赔记录相关联。
结果
在 777 名参与者中，460 名（59.2%）在平均 5.0（SD=2.6）年期间住院；222 名（28.6%）至少有一次选择性住院，418 名（53.8%）至少有一次非选择性住院。混合效应回归模型估计了与无住院相比，每种类型的住院前后全球认知的变化，调整了年龄、性别、教育、医疗状况、住院时间、手术、重症监护病房和合并症。未住院的人每年平均丧失 0.051 个全球认知单位。相比之下，选择性住院前后的下降速度没有显著差异（每年 0.044 个单位）。相比之下，非选择性住院前的下降速度更快（每年 0.076 个单位；估计值=-0.024，SE=0.011，=0.032），在非选择性住院后，每年的平均损失增加了 0.036 个单位（SE=0.005，<0.001），达到每年 0.112 个单位，是未住院患者的两倍多。
结论
与选择性住院相比，非选择性住院与认知能力下降的加速更为明显，即使考虑到住院前的下降也是如此。这些发现可能为哪些住院治疗对老年人的认知健康构成最大风险提供信息。
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