Not that any of us needs another reason to avoid going to the hospital, but a new study done by Robert S. Wilson, PhD at Rush University in Chicago, published in the journal, Neurology, reports some particularly troubling results. Read more
1870 adults over the age of 65 were followed over a period of 9 years and were tested on their memory and cognitive skills before they had a hospital stay and then several times after. What the researchers found was that the participants’ memory and thinking skills were twice as likely to decline after a hospital stay. In other words their cognitive decline sped up. In addition, people’s long term memory suffered the most—it declined three times the normal rate after the first hospitalization.
What’s interesting about this study is that researchers found that the patients’ cognitive decline had little to do with the illness that put them in the hospital in the first place.
After discussing this last Tuesday during my weekly radio segment on Health, Wealth and Happiness, the findings of this study have stayed with me ever since. We’re all aware of the deadly medical errors that occur in hospitals every year. But this new study suggests that something happens to the older patient’s brain as a direct result of being in the hospital. I’ve been mulling over why memory and thinking skills would progressively decline across the board no matter the length of the hospital stay.
Here’s what we do know:
- Delirium occurs in 1/3 of hospitalized patients who are over the age of 65 and in 75% of older patients in the ICU. According to the Mayo Clinic, delirium is a disturbance in a person’s mental abilities that results in a decreased awareness of one’s environment and confused thinking. The onset of delirium is usually sudden, often within hours or a few days.
- New medications are introduced during a hospitalization. Common prescriptions are sleep aids, anti-anxiety medications, anti depressant drugs, allergy medications and cold remedies. This can be a problem for patients who are already taking multiple medications. Patients have much more control over which medications they take when they are at home.
- Lack of sleep is a problem in any hospital. Not just because you’re woken up during the night to have your vital signs taken but the noise level because of beeping machines, louds speakers, people talking in the halls, phones ringing and more.
- Hospital stays can trigger “hospital psychosis” or “ICU psychosis”, a cluster of symptoms that include confusion, hallucinations, disorientation, delusions and more.
- Older patients can be at risk for malnutrition. Studies cite that 58% of patients 65 and older have problems eating. Either the meal tray is taken away before it is eaten, or patients literally have trouble getting to their food or the food tastes just plain bad. (Some hospitals are making great strides to provide healthier and better tasting food).
- Patients are usually immobile and lying in bed most of the time and do not exercise.
We can only speculate as to why this kind of memory and cognitive decline occurs in hospitalized patients. Here are a few suggestions that might help ward off the decline the study reports.
Tips to Help Ward Off Cognitive Decline During a Hospital Stay
- Enlist a loved one or several loved ones to help you while you are a patient in the hospital. If you know an older loved one in the hospital, get involved and implement these strategies.
- If you are mobile, get some exercise. Walk the halls. Ask a loved one to prompt you to walk and to walk with you.
- Ask a loved one to create a list of your current m3edications and their dosages. Include allergies to medications. Ask her/him to create a list of the new medications and their dosages that were introduced in the hospital. Together with your loved one (if you are able) discuss the medications and possible drug interactions with your doctor. Ask your loved one to take both lists of medications to your local pharmacist and have the same discussion. Your local pharmacist knows you.
- Ask a loved one to bring in a healthy meal for you once a day during your stay. She must discuss this with your primary nurse and get her/his okay. Ask your visiting loved ones to keep an eye on the meals you are given and if you have consumed them.
- Lack of sleep in the hospital is not so easy to solve. Medical professionals might be waking you up several times a night to take your vital signs. You can try ear plus, a sound machine or soft music to blot out noise, that is if you don’t have a roommate. Ask for a private room. This cuts in half the number of people who enter your room at all hours. If you have a roommate, not only will you be dealing with your medical professionals in the middle of the night but you’ll be hearing your roommate’s as well.
- Ask a loved one to bring in mentally stimulating games such as crossword puzzles, games you enjoy on your computer, smart phone or other electronic device. Even a newspaper with news from the outside world can help stimulate your brain.
- Be in regular contact with your physician during your hospital stay and after your discharge.
THE GOOD NEWS
There are geriatric emergency rooms springing up all over the country. These ERs cater to the needs of geriatric populations.
Many offer:
-non-skid floors (to prevent falls)
-railings along the walls (to prevent falls)
-volunteers to help stimulate patients and to make sure patients have their hearing aids and glasses.
-thicker mattresses (aimed at preventing bed sores)
-artificial skylights which darken at night (to prevent ‘sundowning’)
-phone calls to patients to see how they are doing after they have returned home. Considering up to 27% of older patients return to the hospital with an emergency within three months, this sounds like a great idea.
-pharmacists that look at possible drug interactions
-visiting nurses to make home visits to look for possible fall hazards.
Camilla Brewster
On Point #2 of What we do know – Currently there exists a conflict of interest between hospitals and pharmaceutical companies. Typically included with the admission paperwork patients or their families sign is a misleading agreement regarding the use of certain drugs in favor of others based on the premise that these drugs are more cost effective. I have found that once that paperwork is signed, the list of drugs prescribed by the attending physician(s) grows exponentially. In the case of my Grandmother she entered the hospital with 5 medications and was prescribed 18, 5 of which were medications to replace the 5 she had taken (generics) with the favored brands of the hospital (kickbacks?) and 13 others that it turned out were unnecessary. Is it any wonder there is cognitive decline during and after hospital stays? This is rampant patient abuse and insurance mining to further the financial positions of hospitals, pharmaceutical companies, and doctors. It’s disgraceful. We need to work together to change these deceptive and abusive practices. Thank you.
Martine
Completely agree with you. The brand medication in the hospital was on their formulary? How unusual. Your grandmother is such a typical case, unfortunately. It happened with my mother and godmother too–more medications, more medications. You can bring in your own medications from home or from your own pharmacy into the hospital–the medications you are already on anyway. Give them in the bottles to the primary nurse and ask that these be given to your loved one that the hospital. Sometimes hospitals don’t have the exact medication a patient is on so they supplement with something else. And sometimes patients do better on the medications they’ve been taking already.
You are right on with your comment about it being no wonder there is cognitive decline in hospitals. Yes! We need to work together to change this. Thank you for posting a great response!