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Most Patients who survive Sepsis are likely
to have Cognitive Issues
Newswise — 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.
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. It’s 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 Service’s 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 Alzheimer’s 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 NIA’s 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.
