@article {8126, title = {Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke.}, journal = {Circ Cardiovasc Qual Outcomes}, volume = {7}, year = {2014}, note = {Times Cited: 1 0 1}, month = {2014 Nov}, pages = {863-71}, publisher = {7}, abstract = {

BACKGROUND: We assessed the acute and long-term effect of myocardial infarction (MI) and stroke on postevent functional disability and cognition while controlling for survivors{\textquoteright} changes in functioning over the years before the event.

METHODS AND RESULTS: Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we determined within-person changes in functional limitations (basic and instrumental activities of daily living) and cognitive impairment after hospitalization for stroke (n=432) and MI (n=450), controlling for premorbid functioning using fixed-effects regression. In persons without baseline impairments, an acute MI yielded a mean acute increase of 0.41 functional limitations (95\% confidence interval [CI], 0.18-0.63) with a linear increase of 0.14 limitations/year in the following decade. These increases were 0.65 limitations (95\% CI, 0.07-1.23) and 0.27 limitations/year afterward for those with mild-to-moderate impairment at baseline. Stroke resulted in an acute increase of 2.07 (95\% CI, 1.51-2.63) limitations because of the acute event and an increase of 0.15 limitations/year afterward for those unimpaired at baseline. There were 2.65 new limitations (95\% CI, 1.86-3.44) and 0.19/year afterward for those with baseline mild-to-moderate impairment. Stroke hospitalization was associated with greater odds of moderate-to-severe cognitive impairment (odds ratio, 3.86; 95\% CI, 2.10-7.11) at the time of the event, after adjustment for premorbid cognition but MI hospitalization was not.

CONCLUSIONS: In this population-based cohort, most MI and stroke hospitalizations were associated with significant increases in functional disability at the time of the event and in the decade afterward. Survivors of MI and stroke warrant screening for functional disability over the long-term.

}, keywords = {Activities of Daily Living, Cognition, Cognition Disorders, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Hospitalization, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Odds Ratio, Retrospective Studies, Stroke, Time Factors, United States}, issn = {1941-7705}, doi = {10.1161/HCQ.0000000000000008}, author = {Deborah A Levine and Dimitry S Davydow and Catherine L Hough and Kenneth M. Langa and Mary A M Rogers and Theodore J Iwashyna} } @article {7801, title = {Functional disability, cognitive impairment, and depression after hospitalization for pneumonia.}, journal = {Am J Med}, volume = {126}, year = {2013}, month = {2013 Jul}, pages = {615-24.e5}, abstract = {

OBJECTIVE: The study objective was to examine whether hospitalization for pneumonia is associated with functional decline, cognitive impairment, and depression, and to compare this impairment with that seen after known disabling conditions, such as myocardial infarction or stroke.

METHODS: We used data from a prospective cohort of 1434 adults aged more than 50 years who survived 1711 hospitalizations for pneumonia, myocardial infarction, or stroke drawn from the Health and Retirement Study (1998-2010). Main outcome measures included the number of Activities and Instrumental Activities of Daily Living requiring assistance and the presence of cognitive impairment and substantial depressive symptoms.

RESULTS: Hospitalization for pneumonia was associated with 1.01 new impairments in Activities and Instrumental Activities of Daily Living (95\% confidence interval [CI], 0.71-1.32) among patients without baseline functional impairment and 0.99 new impairments in Activities and Instrumental Activities of Daily Living (95\% CI, 0.57-1.41) among those with mild-to-moderate baseline limitations, as well as moderate-to-severe cognitive impairment (odds ratio, 2.46; 95\% CI, 1.60-3.79) and substantial depressive symptoms (odds ratio, 1.63; 95\% CI, 1.06-2.51). Patients without baseline functional impairment who survived pneumonia hospitalization had more subsequent impairments in Activities and Instrumental Activities of Daily Living than those who survived myocardial infarction hospitalization. There were no significant differences in subsequent moderate-to-severe cognitive impairment or substantial depressive symptoms between patients who survived myocardial infarction or stroke and those who survived pneumonia.

CONCLUSIONS: Hospitalization for pneumonia in older adults is associated with subsequent functional and cognitive impairment. Improved pneumonia prevention and interventions to ameliorate adverse sequelae during and after hospitalization may improve outcomes.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cognitive Dysfunction, depression, Hospitalization, Humans, Logistic Models, Longitudinal Studies, Middle Aged, Myocardial Infarction, Pneumonia, Stroke}, issn = {1555-7162}, doi = {10.1016/j.amjmed.2012.12.006}, author = {Dimitry S Davydow and Catherine L Hough and Deborah A Levine and Kenneth M. Langa and Theodore J Iwashyna} }