Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents

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 hos...

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Bibliographic Details
Published in:JAMA network open 2021-04, Vol.4 (4), p.e217528
Main Authors: Gracner, Tadeja, Agarwal, Mansi, Murali, Komal P, Stone, Patricia W, Larson, Elaine L, Furuya, E Yoko, Harrison, Jordan M, Dick, Andrew W
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Alzheimer Disease - epidemiology
Cognition & reasoning
Cognitive ability
Cognitive Dysfunction - epidemiology
Cohort Studies
Dementia - epidemiology
Female
Hospitalization
Hospitalization - statistics & numerical data
Humans
Infections
Infections - epidemiology
Infectious Diseases
Longitudinal Studies
Male
Medicare
Nursing Homes
Online Only
Original Investigation
Sepsis
Sepsis - epidemiology
United States
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Summary: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. 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 
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2021.7528