title: Cognitive decline in high-functioning older persons is associated with an increased risk of hospitalization.
abstract: OBJECTIVE
  To examine hospital use for patients with evidence of cognitive decline indicative of early cognitive impairment.
  
  
  METHODS
  Medicare Part A hospital utilization data were linked to data from the MacArthur Research Network on Successful Aging Community Study to examine the association between baseline cognition and decline in cognitive function over a 3-year period and any hospitalization over that same period.
  
  
  METHODS
  New Haven, Connecticut, and East Boston, Massachusetts.
  
  
  METHODS
  Subjects (N=598) were from two sites of the MacArthur Research Network on Successful Aging Community Study, a 7-year cohort study of community-dwelling older persons with high physical and cognitive functioning.
  
  
  METHODS
  Multivariate logistic regression was used to determine the association between any hospitalization over 3 years (1988-91) as the outcome variable and baseline cognitive function and decline in cognition over 3 years as primary predictor variables. Decline was based upon repeated (1988 and 1991) measures of delayed verbal recall and the Short Portable Mental Status Questionnaire (SPMSQ).
  
  
  RESULTS
  Of 598 subjects, 48 died between 1988 and 1991. No baseline (1988) delayed recall scores or change in recall scores (1988-91) were associated with hospitalization. Although 48.2% declined on verbal memory scores, decline was not associated with risk of hospitalization. Of 494 subjects with complete 3-year data, 31.2% declined at least one point on the SPMSQ, and 4.7% declined more than two points. Among individuals aged 75 and older at baseline, the adjusted odds ratio for hospitalization for those who declined more than 2 points compared with those who declined less was 7.8 (95% confidence interval=2.0-30.8).
  
  
  CONCLUSIONS
  Although specific memory tests were not associated with hospitalization, high-functioning older persons who experienced decline in overall cognitive function were more likely to be hospitalized. Variation in baseline cognitive function in this high-functioning cohort did not affect hospitalization, but additional research is needed to evaluate associations with other healthcare costs.
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. jchodosh@mednet.ucla.edu
authors.forename: Joshua
authors.initials: J
authors.lastname: Chodosh
authors.forename: Teresa E
authors.initials: TE
authors.lastname: Seeman
authors.forename: Emmett
authors.initials: E
authors.lastname: Keeler
authors.forename: Ase
authors.initials: A
authors.lastname: Sewall
authors.forename: Susan H
authors.initials: SH
authors.lastname: Hirsch
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: David B
authors.initials: DB
authors.lastname: Reuben
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001900:Boston / Q000453:epidemiology; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003237:Connecticut / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D016344:Medicare Part A / Q000706:statistics & numerical data; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013997:Time Factors