Image of Andrew W. Dick, Ph.D.
Andrew W. Dick, Ph.D.

Infection-related hospitalizations increase the odds of reduced cognitive function in nursing home residents, especially those with certain risk factors, a new study finds.

Investigators analyzed Minimum Data Set Medicare hospitalization records from more than 20,000 nursing home residents aged 65 years or older. Participants had at least two assessments before their infection-related hospital admission, and four or more assessments afterwards.

Within the first quarter following an infection-related hospitalization, the prevalence of severe cognitive impairment was 18% higher than what would be expected if participants hadn’t been admitted for infection, reported Andrew W. Dick, Ph.D., of the RAND Corp., Boston, and colleagues. The findings held after researchers adjusted for pre-hospitalization cognitive scores and other health conditions. 

This “abrupt” loss of cognitive function then persisted for at least six quarters after the original transfer to the hospital, they added. Sustained cognitive decline after hospital discharge was found to be particularly high among residents who had experienced sepsis, those aged 85 years or older, and those with Alzheimer’s disease and related dementias, Dick said.

Residents’ cognitive function was measured using the Cognitive Function Scale. Scores ranged from one (intact) to four (severe cognitive impairment). Initially, study participants had a mean CFS score of 2.17 and a 9% prevalence of severe cognitive impairment. 

Careful monitoring of cognitive function before and after infection-related hospitalization is essential for residents at high risk for cognitive decline, Dick and colleagues contended. Infection-related hospitalizations are largely avoidable, they wrote, and superior outcomes have been found by implementing effectively managed preventive care in nursing homes. 

Yet despite decreased hospitalization rates of residents overall, infection-related hospitalizations increased by 7% from 2011 to 2017, they noted. “Strengthening programs for infection control and management within nursing homes thus remains a national priority,” they concluded.

The study was published in JAMA Network Open.