Hospitalization can speed cognitive decline in elderly

By Janice Lloyd, USA TODAY

Hospitalization of older people might place them at higher risk for accelerated cognitive decline, according to a study released Wednesday.

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Ryan McVay, Getty Images

This is the first study "to measure cognitive function enough times before and after hospitalization to determine the effect of hospitalization on the rate of cognitive change."."

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Ryan McVay, Getty Images

This is the first study "to measure cognitive function enough times before and after hospitalization to determine the effect of hospitalization on the rate of cognitive change."."

Rates of decline occurred twice as fast among elderly patients on average after a hospital stay compared with their previous rate of decline and with older people not admitted to a health care facility. Some mental change is considered a normal part of aging, but advanced decline is associated with risk of disability and loss of independence, dementia and death.

"Understanding a link to cognitive decline to something as common as a hospital stay is very important," says lead author Robert Wilson, a neuropsychologist at Rush University Medical Center in Chicago. "Hospitals can be a very risky experience for the elderly and we think people need to understand that."

While other experts on aging have noticed the negative impact hospitals have on some elderly patients, the authors say this is the first study "to measure cognitive function enough times before and after hospitalization to determine the effect of hospitalization on the rate of cognitive change."

The study involved 1,870 people ages 65 and older enrolled in the Chicago Health and Aging Project. Among those, 71% were hospitalized at least once during the study. Researchers administered four tests of memory and thinking skills every three years, making an overall measure of cognition skill based on the total of the four scores.

The rate of decline after hospitalization would be "equivalent to being more than 10 years older," Wilson said. The research, published in Neurology, was funded by the National Institutes of Health and National Institute on Aging.

"The hospital can be a bad place to go if you're an older individual," says physician Marie Bernard, deputy director of the National Institute on Aging. . "It should be avoided if possible, but that doesn't mean patients shouldn't see their health care provider. They need to do that."

Other findings:

•The rate of decline was three times faster on long-term memory tests after the first hospitalization and 1.5 times faster on a complex attention test.

•More severe illness, longer hospital stay and older age were associated with even faster cognitive decline after hospitalization.

Hospitals need to change how they care for the elderly, says Barbara Resnick, president of the American Geriatrics Society and professor of nursing at the University of Maryland School of Medicine. She says patients spend too much time in bed — alone and attached to monitors — instead of getting up, being encouraged to exercise or sit in a chair and have contact with others, behaviors that motivate patients to stay strong.

"Are we surprised at these findings? No," she says. "You see this a lot. The focus of acute care is taking care of the medical problem and not the care of the elderly down the road. Cognitive function is the last thing to be considered."

Wilson says a small group of participants did not show decline; he adds that additional studies need to be done to explain why certain elderly patients are more resilient.

"What we showed is that once you get out of the hospital your trajectory is downhill," he says. "In general, once people start declining they tend not to improve."

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Summer Programs at CSTC!

Summer Programs

Our programs are tentatively scheduled on Tuesdays, Wednesdays or Thursdays. Call to reserve your spot!

Occupational and Speech Therapy “Mini Groups”

Groups are small, progress is big, with these extended sessions. The goal of these cost effective mini groups are based on your child’s current IEP or individual therapy goals. Mini Groups join 2-3 children and are available for a variety of ages and disorders. Speech and Occupational therapy Mini Groups are forming now!

Academic Tutoring “Mini Groups”

Keep your child’s school skills sharp through the summer! Tutoring by certified teachers is available in all grade levels and subjects. These mini groups are a cost effective way to maintain and/or learn new skills for success in school.

Happy Hands

This group focuses on new and fun ways to promote correct grasp patterns and improve fine motor skills. This group is ideal for children who have trouble with writing tools and hand skills as well as those who need an extra “boost” in writing.

It Takes 2

Come play with your kids! A group for children to attend with their parents. Focus of the group is to promote speech and language skills, socializa-tion, and play skills as well as teach parents to facilitate language and communication skills for their children.

Buddy Bunch

Making friends and fitting in with peers is an important part of child-hood. This fun group focuses on social skills and cover topics such as; conversational skills, cooperative play and self

regulation.

Crafty Kids

Messy projects, paper mache, and modeling mixtures, will expose kids to unique tactile experiences and sensory exploration. Through creative art, the group will teach pre-writing, cutting and basic fine motor skills at the com-fort level and developmental ability of each individual.

Handwriting Help

Is your child's writing illegible? This remedial class is designed to help kids who have illegible handwriting or difficulty writing. Printing is reviewed using the First Strokes Program. Children are taught to recognize common handwriting errors and progress through a series of exercises to correct their own errors.

Fun With Food

“Problem Eaters/Feeders” will benefit from this sensory based approach. The group is designed to increase a child's comfort level with a variety of foods and progress to experimenting with different textures. If your child refuses to try new food, has a limited diet, is picky about brands or containers or has stopped eating foods they previously ate, this group is for you.

Mini Movers

This group focuses on providing experiences that encourage children to walk, run, jump, and climb. Sensory play activities are also introduced to expose children to additional ways of learning and exploring. Socialization with peers is easily facilitated in the open room and at mini stations. Parent instruction on easy ways to replicate similar therapeutic activities at home will be provided.

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Adult Neuro Rehabilitation and What OT/PT/ST Can Do For You!

Adult Neuro Rehabilitation and What OT/PT/ST Can Do For You!

At Comprehensive Speech and Therapy Center, we recognize that suffering a stroke or other neurological ailment can affect your ability to perform those tasks that are important to you. Our team of occupational, physical and speech therapists work as a team with you to restore your ability to complete your daily tasks with the least amount of restrictions possible. We work with you one-on-one or in a  co-treating situation with an additional therapist to provide the most conducive environment for therapy.

Occupational therapists are concerned with your ability to complete activities of daily living which include, but are not limited to personal grooming/hygiene, transfers, preparing meals and completing housework and even getting you back into the workplace. Therapists break down activities into their component parts and practice those steps with a focus on ease and safety, then put the activity back together and work on the task as a whole. The goal is to restore performance, or teach compensatory strategies for individuals to relearn how to complete tasks safely.  Often individuals suffering from strokes avoid using their affected side; therefore occupational therapists work to encourage the individuals to avoid disuse of the affected limbs and teach strategies to incorporate the affected side in everyday tasks. The main focus for occupational therapy is establishing ways of completing tasks by altering the components such as using one handed dressing techniques, reworking the task, and modifying the home to allow the individual the ability to complete the task in the least restrictive environment possible.

Physical therapists focus on treating disabilities related to motor and sensory impairments. These therapists focus on restoring natural movement of the body. These therapists assess range of motion, strength, endurance, gait and sensation to gather information to develop an individualized treatment plan that focuses on regaining functional mobility within the home and community. They aim to reduce the residual deficits and establish home exercise programs to allow the individual to continue their rehabilitation at home working on isolated muscles and muscle groups as a whole to practice skills such as balance, coordination, and ambulation with and without an assistive device, ascending/descending stairs, and maneuvering around obstacles safely.

Speech-language pathologists can help individuals relearn how to use language or develop alternative means of communicating, as well as evaluating the potential need for an augmentative communication device.  They can assist in improving the ability to chew and swallow as well as work on cognitive strategies and social skills. Short and long term memory problems are often a concern. These can include following directions, comprehension skills and task initiation.

Strokes and other neurological dysfunctions can cause changes in sensation, muscle tone and reflexes, making chewing and swallowing foods difficult. Speech and occupational therapists can work independently and as a team to minimize chewing and swallowing difficulties by positioning the individual, changing the thickness of foods and liquids, improve motor coordination and breaking down the steps to increase independence in chewing and swallowing.  

Allison Ackels, OTR/L, CSCS

Allison earned her bachelor’s degree in Kinesiology, specializing in fitness leadership and health promotions from Michigan State University and earned her master’s degree in Occupational Therapy from Baker College. She has worked in a variety of settings including hospitals and skilled nursing facilities. She worked as a student athletic trainer at Michigan State University for women's crew, football, dance, hockey and baseball teams. She is also a certified strength and conditioning coach through the National Strength and Conditioning Association.   Allison has been patiently training her Newfoundland, Diesel, to become a therapy dog.  Diesel has grown out of his rambunctious stage and loves meeting new people.

Photo sources: occupationaltherapyonline.net & stmaryhealthcare.org

Copyright 2012 Comprehensive Speech and Therapy Center

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