Senior Citizens
That Survive Sepsis Are Three Times More Likely to Have Cognitive Issues
First large-scale
study shows older patients with severe sepsis face
years of cognitive, physical decline, according to U-M research
published in JAMA
Oct. 26, 2010 -
Older adults who survive severe sepsis are at higher risk for long-term
cognitive impairment and physical limitations than those hospitalized
for other reasons, according to researchers from the University of
Michigan Health System.
Research to be
published Oct. 27 in the Journal of the American Medical Association
showed that 60 percent of hospitalizations for severe sepsis were
associated with worsened cognitive and physical function among surviving
older adults. The odds of acquiring moderate to severe cognitive
impairment were 3.3 times higher following an episode of sepsis than for
other hospitalizations.
The scientists
analyzed Medicare claims data from 516 people who survived 623
hospitalizations for severe sepsis between 1998 and 2005. The average
age of participants was 77 at the time of hospitalization.
Severe sepsis
also was associated with greater risk for the development of new
functional limitations following hospitalization, says lead author,
Theodore (Jack) Iwashyna, M.D., Ph.D., assistant professor of internal
medicine at U-M.
Among patients
who had no limitations before sepsis, more than 40% developed trouble
with walking. Nearly 1 in 5 developed new problems with shopping or
preparing a meal. Patients often developed new problems with such basic
things as bathing and toileting themselves.
We used to
think of sepsis as just a medical emergency, an infection that you get
sick with and then recover, said Iwashyna, But we discovered a
significant number of people face years of problems afterwards.
Those problems
are bigger and more common than we expected. Most older Americans suffer
real brain and body problems. We need new treatments, not just for the
sepsis infection, but to prevent these new disabilities afterwards.
Sepsis is an
overwhelming infection that can result in failure of multiple organ
systems. The initial infections are often common problems, such as
pneumonia or a urinary tract infection. About 40 percent of those with
severe sepsis die from the infection.
Anyone can get
sepsis, but older people and those with weakened immune systems are most
vulnerable. Sepsis is probably the most common cause of critical illness
in the United States.
The best data
available are from the 1990s, when it was estimated that 750,000 people
each year were diagnosed with sepsis. Researchers believe that number
has doubled each decade.
These new data
show a majority of older patients suffer with real life-changing burdens
after beating sepsis. This is an underrecognized public health problem
with major implications for patients, families and the health care
system, Iwashyna says.
We need to make
sure families have the resources they need to care for survivors of
sepsis when they go home. Its not enough just to get them through the
acute episode. We need to start preparing them for the years of problems
they may have afterwards.
This research
underscores the need for physicians who care for older adults to focus
early on preventing infections that can lead to sepsis, says study
co-author Kenneth M. Langa, M.D., Ph.D., a core investigator for the Ann
Arbor Veterans Administration Health Services Research and Development
Services Center of Excellence and professor of internal medicine at
U-M.
Older patients
need to get their flu and pneumonia vaccines in order to decrease their
risk for infections, and physicians need to be aware of the long-term
risk for cognitive and physical disabilities that many patients may
face, Langa said.
In contrast to
Alzheimers disease and other forms of dementia, the cognitive
impairment associated with sepsis is likely at least partially
preventable through better acute care of the sepsis episode and better
rehabilitation efforts afterwards, Langa says.
We need to
start working early from the beginning of the hospitalization to
make sure patients do not develop new disability. There are innovative
new ways to care for people that might help prevent this disability,
Iwashyna says.
The research was
supported primarily by the National Institute on Aging and the National
Heart, Lung and Blood Institute.
The researchers
used data from the NIA-supported Health and Retirement Study , a
long-term study that collects information on the health, economic, and
social factors influencing the health and well-being of a nationally
representative sample Americans over age 50.
"This research
makes clearer how acute medical problems in older adults may have an
important lasting impact and contribute to a downward trajectory in both
cognitive and physical function, says Richard Suzman, Ph.D., director
of the NIAs Division of Behavioral and Social Research, which supports
the HRS.
The unique
nature of the rich HRS dataset that links both survey data and Medicare
administrative data made this innovative study possible and will also
facilitate future studies of the long-term impact of critical illness on
older adults and the family members that care for them.
The HRS, now in
its 18th year, follows more than 22,000 people over the age of 50,
collecting data every two years, from pre-retirement to advanced age.
The NIA leads the
federal effort supporting and conducting research on aging and the
medical, social and behavioral issues of older people. For more
information on research and aging, go to
www.nia.nih.gov.
Additional
authors include E. Wesley Ely, M.D., M.P.H. of the Tennessee Valley
Veterans Affairs (VA) Healthcare System and Vanderbilt University;
Dylan M. Smith, Ph.D., of Stony Brook University Medical Center.
