Last week’s column pointed out research from the Institute of Medicine that emphasized that people who develop delirium in the hospital often end up with mental decline. But even people who don’t develop delirium can have their mental abilities affected simply by being in the hospital.
One study included in the recent IOM report titled Cognitive Aging tracked nearly nineteen hundred older adults for up to twelve years to see how their mental abilities changed over time. It found that people who were living in their own houses or apartments (not in nursing homes) before they went into the hospital declined 2.4 times faster after a hospitalization than they had been declining before the hospital stay.
The result was similar regardless of the patients’ sex, race, education, or level of cognitive functioning in the beginning of the study. That said, the study did find that the problem was greater for people who were sicker or older, and it was greater the longer people stayed in the hospital.
The biggest declines in mental functioning affected short-term memory and executive functioning. Short-term memory involves the ability to remember about seven pieces of data, such as numbers, for roughly 10-60 seconds. Executive functioning involves skills such as solving problems; managing time; and planning, organizing, and completing tasks.
The declines were evident shortly after people left the hospital, and hadn’t improved a great deal a year later.
What does this information mean for you?
First, realize that a hospital stay is a serious matter. If you are considering any elective (optional) surgery, the potential for cognitive decline is one factor to take into account.
Second, if you do need to be in the hospital, take steps to minimize any related mental decline. Until recently, little could be done, but now researchers have concluded that intensive physical and mental rehab can make a big difference, especially if it is started right away.
Researchers at the Vanderbilt University ICU Delirium and Cognitive Impairment Study Group offer eight suggestions at icudelirium.org/cognitive.html: with your doctor’s approval, get vigorous exercise; do brain exercises such as crossword puzzles or Sudoku; use adaptive devices and strategies (e.g., use lists to keep track of details); engage with your social support network; address anxiety or depression; use eyeglasses or hearing aids as needed; get a medical evaluation to identify (or rule out) any medical reasons for cognitive problems, such as drug side effects; and see a neurologist or neuropsychologist to get formal cognitive rehabilitation, the mental equivalent of physical therapy.
Knowing how to reduce the risk of delirium (the subject of last week’s column) and mental decline related to hospital stays can make a huge difference in quality of life for patients and their families.
