Functional Disability, Cognitive Impairment, and Depression After Hospitalization for Pneumonia

doi:10.1016/j.amjmed.2012.12.006

The American Journal of Medicine

Volume 126, Issue 7, July 2013, Pages 615-624.e5

https://doi.org/10.1016/j.amjmed.2012.12.006 Get rights and content

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.

Section snippets

Population

Our study is a secondary analysis of data from the Health and Retirement Study (HRS), a prospective longitudinal investigation of adults aged more than 50 years in the United States. The details of the HRS have been described.7, 8 The HRS protocol was approved by the University of Michigan Institutional Review Board.

We studied all HRS respondents with at least 1 interview from 1998 to 2006 and for whom there were Medicare claims-based data for a subsequent hospitalization for pneumonia,

Results

From 1998 to 2007, there were 1434 individuals who survived 1711 hospitalizations for pneumonia, myocardial infarction, or stroke and completed at least 1 follow-up interview (Figure 1). Table 1 describes the baseline and clinical characteristics of survivors, whose median age was 77 years (interquartile range, 70-83 years). Patients were followed for up to 5 surveys (range, 7.7-9.8 years) before hospitalization and up to 6 surveys (range, 9.9-12.7 years) afterward.

Discussion

In this nationwide cohort of older Americans, we have demonstrated that hospitalization for pneumonia is independently associated with subsequent functional decline, approximately 2.5 times the odds of subsequent moderate-to-severe cognitive impairment and 1.6 times the odds of subsequent substantial depressive symptoms. Of note, these associations were present among those who were hospitalized only once over a 9-year period and those without substantial medical comorbidity, and were not

Conclusions

Hospitalization for pneumonia is associated independently with subsequent new functional impairments and moderate-to-severe cognitive impairment, and may be associated with subsequent substantial depressive symptoms. Future research identifying the mechanisms that link pneumonia with functional disability, cognitive impairment, and depression—along with improved interventions that prevent pneumonia or these negative sequelae—is imperative in light of the aging of the population.

Acknowledgments

The authors thank Laetitia Shapiro and Mohammed Kabeto, both at the University of Michigan, for expert programming.

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: Funding: This work was supported by Grants KL2 TR000421, K08 HL091249, R01 AG030155, and U01 AG09740 from the National Institutes of Health. The Health and Retirement Study is performed at the Institute for Social Research, University of Michigan.

: Conflict of Interest: None. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the National Institutes of Health, or the US government.

: Authorship: All authors had access to the data and played a role in writing this manuscript.

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Clinical research studyFunctional Disability, Cognitive Impairment, and Depression After Hospitalization for Pneumonia

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Population

Results

Discussion

Conclusions

Acknowledgments

Chest

BMC Geriatrics

J Clin Epidemiol

J Chron Dis

Am Heart J

Alzheimers Dement

Am J Geriatr Psychiatry

Ann Epidemiol

Chest

Lancet

Behav Brain Res

Chest

Incidence and cost of pneumonia in Medicare beneficiaries

Chest

Aging population and future burden of pneumococcal pneumonia in the United States

J Infect Dis

Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia

JAMA

Pneumonia: still the old man's friend?

Arch Intern Med

Long-term cognitive impairment and functional disability among survivors of severe sepsis

JAMA

Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans

Am J Geriatr Psychiatry

Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness

J Gerontol A Biol Sci Med Sci

Association of incident dementia with hospitalizations

JAMA

Increased mortality risk in women with depression and diabetes mellitus

Arch Gen Psychiatry

Clinical research study
Functional Disability, Cognitive Impairment, and Depression After Hospitalization for Pneumonia