The Institute of Medicine, an independent non-profit organization created by Congressional charter in 1970 to advise the government on matters of health policy, recently published a 373-page report on cognitive aging.  (Search the web for [IOM cognitive aging] to download a free copy.) 

Cognitive function, the report explains, involves being able pay attention, think, understand, learn, remember, solve problems, and make decisions.  As people age, cognitive function normally changes, even if people never develop dementia or other disorders.  While many of us assume that these changes involve only declines, the report is careful to note that some cognitive abilities can improve with age.  The declines, though, are what people tend to worry about as they get older. 

The report lists a number of medical conditions that can develop over many decades and make cognitive decline worse, such as high blood pressure and obesity. However, one it lists that can occur in just a few days and cause significant decline is delirium (confusion and disordered thinking) that develops in the hospital. 

The report notes that “up to 50% of all Americans ages 65 and older will develop delirium during the course of a hospitalization. . . Although common, delirium is preventable in some 30 to 50 percent of cases. . . and every effort should be made to prevent it, as it significantly increases a person’s risk for long-term cognitive decline and dementia.” 

What if people already have trouble thinking due to dementia such as Alzheimer’s? In those cases, a few days of delirium can make the mental decline much worse.  But even if people were functioning normally before a hospital stay, delirium can cause serious and permanent mental decline.

Dozens of studies, the IOM reports, have shown that non-drug approaches to preventing delirium work well.  It highlights the efforts of the Hospital Elder Life Program (HELP), which offers information for both medical professionals and patients/families about steps to take to prevent delirium.

A brochure available on HELP’s website (hospitalelderlifeprogram.org) lists ten steps patients and family members can take to reduce the risk of delirium in the hospital.  These include:  bring to the hospital a list of all medicines the patient is taking; bring a medical information sheet listing allergies, all known diagnoses, and contact information for the patient’s doctors; bring glasses, hearing aids, and dentures to the hospital; bring familiar objects from home; repeatedly remind patients where they are and why they are there; give instructions one step at a time; consider arranging for massage; stay with the patient as much as possible; tell the doctor or nurse right away if the patient seems confused; and learn more about delirium.

Next week’s column will talk more about cognitive decline resulting from hospital stays.