RAND Corporation, Arlington, Virginia.
Now with RAND Corporation, Santa Monica, California.
JAMA Netw Open. 2021 Apr 1;4(4):e217528. doi: 10.1001/jamanetworkopen.2021.7528.
Hospitalizations for infections among nursing home (NH) residents remain common despite national initiatives to reduce them. Cognitive impairment, which markedly affects quality of life and caregiving needs, has been associated with hospitalizations, but the association between infection-related hospitalizations and long-term cognitive function among NH residents is unknown.
To examine whether there are changes in cognitive function before vs after infection-related hospitalizations among NH residents.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Minimum Data Set 3.0 linked to Medicare hospitalization data from 2011 to 2017 for US nursing home residents aged 65 years or older who had experienced an infection-related hospitalization and had at least 2 quarterly Minimum Data Set assessments before and 4 or more after the infection-related hospitalization. Analyses were performed from September 1, 2019, to December 21, 2020.
Infection-related hospitalization lasting 1 to 14 days.
Using an event study approach, associations between infection-related hospitalizations and quarterly changes in cognitive function among NH residents were examined overall and by sex, age, Alzheimer disease and related dementias (ADRD) diagnosis, and sepsis vs other infection-related diagnoses. Resident-level cognitive function was measured using the Cognitive Function Scale (CFS), with scores ranging from 1 (intact) to 4 (severe cognitive impairment).
Of the sample of 20 698 NH residents, 71.0% were women and 82.6% were non-Hispanic White individuals; the mean (SD) age at the time of transfer to the hospital was 82 (8.5) years. The mean CFS score was 2.17, and the prevalence of severe cognitive impairment (CFS score, 4) was 9.0%. During the first quarter after an infection-related hospitalization, residents experienced a mean increase of 0.06 points in CFS score (95% CI, 0.05-0.07 points; P < .001), or 3%. The increase in scores was greatest among residents aged 85 years or older vs younger residents by approximately 0.022 CFS points (95% CI, 0.004-0.040 points; P < .05). The prevalence of severe cognitive impairment increased by 1.6 percentage points (95% CI, 1.2-2.0 percentage points; P < .001), or 18%; the increases were observed among individuals with ADRD but not among those without it. After an infection-related hospitalization, cognition among residents who had experienced sepsis declined more than for residents who had not by about 0.02 CFS points (95% CI, 0.00-0.04 points; P < .05). All observed differences persisted without an accelerated rate of decline for at least 6 quarters after infection-related hospitalization. No differences were observed by sex.
In this cohort study, infection-related hospitalization was associated with immediate and persistent cognitive decline among nursing home residents, with the largest increase in CFS scores among older residents, those with ADRD, and those who had experienced sepsis. Identification of NH residents at risk of worsened cognition after an infection-related hospitalization may help to ensure that their care needs are addressed to prevent further cognitive decline.
重要性：尽管国家采取了减少疗养院（NH）居民感染住院的措施，但感染住院的情况仍然很常见。认知障碍严重影响生活质量和护理需求，与住院有关，但 NH 居民感染相关住院与长期认知功能之间的关系尚不清楚。
目的：研究 NH 居民在感染相关住院前后认知功能是否发生变化。
设计、地点和参与者：本队列研究使用了来自 2011 年至 2017 年美国 65 岁及以上经历过感染相关住院且在感染相关住院前后至少有 2 个季度最低数据集评估的 NH 居民的最低数据集 3.0 与 Medicare 住院数据相关联。分析于 2019 年 9 月 1 日至 2020 年 12 月 21 日进行。
暴露：持续 1 至 14 天的感染相关住院。
主要结果和措施：使用事件研究方法，总体上和按性别、年龄、阿尔茨海默病和相关痴呆症（ADRD）诊断以及脓毒症与其他感染相关诊断，研究了感染相关住院与 NH 居民每季度认知功能变化之间的关联。居民的认知功能使用认知功能量表（CFS）进行测量，得分范围为 1（完整）至 4（严重认知障碍）。
结果：在 20698 名 NH 居民中，71.0%为女性，82.6%为非西班牙裔白人；转移到医院时的平均（SD）年龄为 82（8.5）岁。平均 CFS 评分为 2.17，严重认知障碍（CFS 评分，4）的患病率为 9.0%。在感染相关住院后的第一个季度，居民的 CFS 评分平均增加了 0.06 分（95%CI，0.05-0.07 分；P < .001），即 3%。85 岁及以上的居民比年轻居民的分数增加了约 0.022 CFS 点（95%CI，0.004-0.040 点；P < .05）。严重认知障碍的患病率增加了 1.6 个百分点（95%CI，1.2-2.0 个百分点；P < .001），即 18%；在患有 ADRD 的个体中观察到了这些增加，但在没有 ADRD 的个体中没有观察到这些增加。感染相关住院后，经历过脓毒症的居民的认知能力下降幅度大于未经历过脓毒症的居民，约为 0.02 CFS 点（95%CI，0.00-0.04 点；P < .05）。至少在感染相关住院后 6 个季度，所有观察到的差异都持续存在，且没有加速下降的趋势。未观察到性别差异。
结论和相关性：在这项队列研究中，感染相关住院与 NH 居民的认知能力立即和持续下降有关，在年龄较大的居民、患有 ADRD 的居民和经历过脓毒症的居民中，CFS 评分的增加最大。确定感染相关住院后认知能力恶化风险较高的 NH 居民，可能有助于确保满足其护理需求，以防止认知能力进一步下降。
