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Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents.
JAMA Netw Open. 2021 04 01; 4(4):e217528.JN

Abstract

Importance

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.

Objective

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.

Exposure

Infection-related hospitalization lasting 1 to 14 days.

Main Outcomes and Measures

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).

Results

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.

Conclusions and Relevance

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.

Authors+Show Affiliations

RAND Corporation, Arlington, Virginia. Now with RAND Corporation, Santa Monica, California.Center for Health Policy, Columbia University School of Nursing, New York, New York. Now with Washington University School of Medicine, St Louis, Missouri.Center for Health Policy, Columbia University School of Nursing, New York, New York.Center for Health Policy, Columbia University School of Nursing, New York, New York.Columbia University School of Nursing, New York, New York. Columbia University Mailman School of Public Health, New York, New York.Department of Medicine, Columbia University Irving Medical Center, New York, New York.RAND Corporation, Pittsburgh, Pennsylvania.RAND Corporation, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

33890988

Citation

Gracner, Tadeja, et al. "Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents." JAMA Network Open, vol. 4, no. 4, 2021, pp. e217528.
Gracner T, Agarwal M, Murali KP, et al. Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents. JAMA Netw Open. 2021;4(4):e217528.
Gracner, T., Agarwal, M., Murali, K. P., Stone, P. W., Larson, E. L., Furuya, E. Y., Harrison, J. M., & Dick, A. W. (2021). Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents. JAMA Network Open, 4(4), e217528. https://doi.org/10.1001/jamanetworkopen.2021.7528
Gracner T, et al. Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents. JAMA Netw Open. 2021 04 1;4(4):e217528. PubMed PMID: 33890988.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents. AU - Gracner,Tadeja, AU - Agarwal,Mansi, AU - Murali,Komal P, AU - Stone,Patricia W, AU - Larson,Elaine L, AU - Furuya,E Yoko, AU - Harrison,Jordan M, AU - Dick,Andrew W, Y1 - 2021/04/01/ PY - 2021/4/23/entrez PY - 2021/4/24/pubmed PY - 2021/8/25/medline SP - e217528 EP - e217528 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 4 N2 - Importance: 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. Objective: 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. Exposure: Infection-related hospitalization lasting 1 to 14 days. Main Outcomes and Measures: 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). Results: 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. Conclusions and Relevance: 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. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/33890988/Association_of_Infection_Related_Hospitalization_With_Cognitive_Impairment_Among_Nursing_Home_Residents_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2021.7528 DB - PRIME DP - Unbound Medicine ER -