Infections in Nursing Homes Often Followed By Cognitive Decline: Study

New research highlights the importance of infectious disease control in nursing homes, indicating residents face an increased risk of cognitive decline if they are hospitalized due to an infection suffered in a nursing home.

In findings published last week in the The Journal of the American Medical Association, researchers with Columbia University and the RAND Corporation determined elderly nursing home residents face a nearly 20% increased risk of cognitive decline after hospitalization with an infection.

A team of investigators analyzed Minimum Data Set Medicare hospitalization records from 2011 to 2017, which included more than 20,000 nursing home residents 65 years of age and older, to examine whether there were any notable changes in cognitive function following an infection resulting in hospitalization.

Subjects were assigned a Cognitive Function Scale score following assessments at least twice quarterly, and four or more times following infection-related hospitalizations.

According to the findings, nursing home residents hospitalized due to infections suffered an 18% higher rate of severe cognitive impairment within the first quarter than would be usually expected. Further data over a period of six weeks suggested the cognitive declines were permanent.

Researchers also noted patients with sepsis infections and those previously diagnosed with Alzheimer’s disease and related dementias scored higher cognitive decline losses, indicating those pre-existing conditions further increased the risk of cognitive decline.

The findings highlight the importance of effective nursing home infection controls, according to researchers. Patients with high risk of cognitive decline should receive careful monitoring and testing throughout their stay at nursing homes, and especially after an infection-related hospitalization to reassess safety risks, according to the study.

Nursing Home Infection Risks

The ongoing COVID-19 pandemic has uncovered widespread infection control problems at nursing homes nationwide, with many facilities showing that they were ill-equipped to handle or minimize the risk of rapidly spreading infectious disease.

In June 2020, the U.S. Centers for Medicare and Medicaid Services (CMS) estimated that a quarter of COVID-19 deaths occurred in the nation’s nursing homes.

The U.S. Government Accountability Office (GAO) issued a report in May 2020, which found that 40% of the nursing homes have been cited for infection control problems.

Investigators reviewed nursing home inspection results collected at 15,500 facilities between 2013 and 2017. According to their findings, 82% of the facilities inspected, or 13,299, had at least one deficiency related to infection control and prevention. The inspectors found infection-related deficiencies over multiple consecutive years in four out of every 10 nursing homes investigated.

Many health experts attributed the significant COVID-19 death rates in long term care facilities to nursing home neglect, which include chronic understaffing and lack of training and protocols to handle common infection outbreaks, let alone a pandemic.

An August 2020 study published in the Journal for the American Medical Association (JAMA), researchers found those states with facilities that have the appropriate amount of nursing home staff perform better at preventing outbreaks than those in states where facilities fared poorly in staffing level assessments.

According to their findings, the one factor which seemed to affect the likelihood of COVID-19 infections was nursing home staffing levels. Facilities which scored higher were less likely to have more than 30 COVID-19 cases, than those who had lower scores for staffing.