Data analysis shows poor long-term cognitive, physical outcomes after prolonged hospitalization

Seriously ill people who are hospitalized in long-term acute care hospitals have poor health outcomes after discharge, according to an NIA-funded study. Eighty percent of adults over age 50 who were admitted to a long-term acute care hospital (LTCH) either died or had severe functional or cognitive impairments within 2.5 years. The findings were published in JAMA Network Open.

LTCHs specialize in treating seriously ill patients who are often transferred from an intensive care (ICU) or critical care unit. Most LTCH patients stay three to four weeks while receiving interdisciplinary care, such as respiratory therapy, head trauma treatment, and pain management. While statistics show that fewer than 50% of adults over age 65 survive the year after an LTCH stay, less is known about functional and cognitive outcomes of patients with serious illnesses who survive their time in an LTCH, and how those outcomes may inform decision making about palliative and long-term acute care for patients, families, clinicians, and caregivers.

To look deeper into the issue, the team led by researchers at the University of California, San Francisco analyzed data from 396 people enrolled in the long-term, nationally representative Health and Retirement Study (HRS) of Americans over age 50. The researchers looked at participant data from 2002 through 2020, which included cognition tests and self-assessments every two years of the level of help needed for activities of daily living (ADL), such as walking, dressing, bathing, eating, toileting, etc. The median age of participants was 75. Half of the participants had experienced a prolonged ICU stay, and 41% had received mechanical ventilation during acute care or LTCH stays. The researchers found that 80% of participants died or survived with severe impairment (functional, cognitive, or both) within 2.5 years after LTCH admission. The team noted that participants who died or survived with severe impairment - defined as needing help in two of more of the ADLs - were older than those who survived with no or mild impairment. The chance of dying or surviving with severe impairment was closely linked to a patient's baseline physical and cognitive health status before LTCH admission. Patients most likely to survive an LTCH stay with reasonably intact function and cognition were those who had a good survival prognosis and either no or mild cognitive or ADL issues before their initial admission.

The researchers believe these results underscore an urgent need for increasing discussions about palliative care and goals of care among older adults facing hospitalization in an LTCH. They note that previous studies have shown only 1% of patients had received palliative care consultation during the hospitalization preceding transfer to or in the LTCH. They hope to expand this research in future studies and provide more detail to reflect recent Medicare policy changes designed to focus LTCHs on more severely ill patients.

This research was supported in part by NIA grants P30AG044281, R03AG078942, T32AG01934, P30AG021342, K24AG054415, and K23AG052603.

These activities relate to NIH's AD+ADRD Research Implementation Milestone 13.Z, "Care & Caregiving: Healthcare Decision Making."

Reference: Jain S, et al. Survival, function, and cognition after hospitalization in long-term acute care hospitals. JAMA Network Open. 2024. Epub May 1. doi: 10.1001/jamanetworkopen.2024.13309.