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Is hospitalization a risk factor for cognitive decline in older age adults?

Published online by Cambridge University Press:  28 September 2020

Lucia Chinnappa-Quinn
School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Department of Anaesthesia, Eastern Health, Melbourne, Victoria, Australia
Steve Robert Makkar
Centre for Healthy Brain and Ageing, University of New South Wales, Sydney, New South Wales, Australia
Michael Bennett
Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Anaesthesia and Hyperbaric Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
Ben C. P. Lam
Centre for Healthy Brain and Ageing, University of New South Wales, Sydney, New South Wales, Australia
Jessica W. Lo
Centre for Healthy Brain and Ageing, University of New South Wales, Sydney, New South Wales, Australia
Nicole A. Kochan
Centre for Healthy Brain and Ageing, University of New South Wales, Sydney, New South Wales, Australia
John D. Crawford
Centre for Healthy Brain and Ageing, University of New South Wales, Sydney, New South Wales, Australia
Perminder S. Sachdev*
Centre for Healthy Brain and Ageing, University of New South Wales, Sydney, New South Wales, Australia Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia
Correspondence should be addressed to: Prof Perminder S. Sachdev, Centre for Healthy Brain Ageing (CHeBA), NPI, Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick, New South Wales 2031, Australia. Phone: +61 (2) 9382 3816; Fax: +61 (2) 9382 3774. Email:



Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD).


We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle–Ottawa Scale.


The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen’s d = −0.25, 95% CI [−0.02, −0.49] I2 35%).


There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.

Review Article
© International Psychogeriatric Association 2020

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