The Relationship between Hospital-Associated Cognitive Decline and Sedative Burden among Medical Older Patients

Background: Sedative-hypnotic medications (SHM) are frequently used in hospitalized older patients, despite the undesirable effects on cognitive status. Although previous studies showed that a significant number of patients experience changes in SHM use during hospitalization, it is still unclear which pattern of change may lead to hospital-acquired cognitive decline (HACD). This study aimed to test the association between patterns of SHM change and HACD. Methods: This secondary analysis study included 550 patients over 70 years old who were cognitively intact at admission (Short Portable Mental Status Questionnaire (SPMSQ) ≥8). HACD was defined as at least 1-point decline in SPMSQ between admission and discharge. Changes in sedative burden (SB) before and during hospitalization were coded using Drug Burden Index (DBI) sorting patients to four groups: without SB (n=254), without SB changes (n=127), increased SB (n=85), and decreased SB (n=84). Results: Incidence of HACD was 233/550 (42.4%). In multivariate logistic analysis controlling for demographic characteristics, length of stay, severity of acute illness, comorbidity, DBI-score at home, and depression, the odds of a HACD were 2.18 (95% CI:1.05–4.53) among patients with increased SB and 1.87 (95% CI: 1.01–3.46) among patient without SB changes, compared to patients with decreased SB during hospitalization. Conclusion: Older patients for whom sedative burden increased or did not change are at higher risk for acquired cognitive decline, compared with those with reduction in SB. Identifying patients with a potential increase in sedative burden and intervening to reduce it, may be helpful in fighting hospital acquired cognitive decline.