Where you live can increase your risk for experiencing delirium after surgery. So said a study that showed older adults who live in the most disadvantaged neighborhoods are two times more likely to experience delirium after surgery than their counterparts from more affluent communities. These findings by researchers from the Aging Brain Center in the Hinda and Arthur Marcus Institute for Aging Research (Marcus Institute) at Hebrew SeniorLife were published today in the Journal of the American Geriatrics Society. Franchesca Arias, Ph.D., Assistant Scientist, and Sharon K. Inouye, M.D., Director of the Aging Brain Center, were lead and senior authors respectively on the study.
Delirium is a clinical syndrome characterized by acute decline in cognition, which can present as inattention, disorientation, lethargy or agitation, and perceptual disturbance. Delirium among older hospitalized patients can lead to poor outcomes, including prolonged hospital stays, deep psychological stress for patients and their families, functional decline, and in worst cases, death. To date, however, the association between delirium and community-based factors that can influence health outcomes, such as resources, health care access, and local economic conditions, has not been well-examined.
The study enrolled a prospective observational cohort of 560 patients aged 70+ undergoing major non-cardiac surgery between June 2010 and August 2013 at two academic medical centers in Boston. The research team used the Area Deprivation Index (ADI) to characterize participant's neighborhood socioeconomic disadvantage.
ADI uses 17 United States Census indicators of poverty, education, employment, and physical environment to characterize the socioeconomic disadvantage of a census block group. This study found that neighborhood characteristics, such as poverty, lack of infrastructure, and density contributed to the two-fold increase in the number of patients who developed delirium after surgery. When compared with other social and economic risk factors for diminished health outcomes in older adults, including income and level of education, neighborhood characteristics emerged as the strongest predictor of delirium incidence.
The COVID-19 pandemic has shone a light on the consequences of economic health care disparities in the U.S., and this study is yet another example of how social, economic, and environmental marginalization impacts the health of those who live in disadvantage communities.
"Our hope is that by building awareness of barriers to care present in disadvantaged neighborhoods, clinical teams will tailor support and treatment recommendations based on the resources available within a patient's community," said Dr. Inouye.
"Patients with higher ADI percentiles may benefit from having additional support and periodic check-ins with treatment teams prior to surgery and/or participating in rehabilitation programs postoperatively," said Dr. Arias.
In addition to Drs. Arias and Inouye, study investigators included Amy J.H. Kind, M.D., Ph.D., Health Services and Care Research Program, Department of Medicine, University of Wisconsin School of Medicine and Public Health/ Madison VA Geriatrics Research Education and Clinical Center; Fan Chen, M.S., M.P.H., Aging Brain Center, Marcus Institute/Biostatistics and Data Sciences, Marcus Institute; Tamara G. Fong, M.D., Ph.D., Aging Brain Center, Marcus Institute and Department of Neurology, Beth Israel Deaconess Medical Center; Haley Shiff, B.A., Harvard T. H. Chan School of Public Health; Margarita Alegria, Ph.D., Disparities Research Unit, Massachusetts General Hospital Department of Medicine and Psychiatry/Harvard Medical School; Edward R. Marcantonio, M.D., S.M., Division of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center; Yun Gou, M.A., Aging Brain Center, Marcus Institute/Biostatistics and Data Sciences, Marcus Institute; Richard N. Jones, Sc.D., Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School; Thomas G. Travison, Ph.D., Biostatistics and Data Sciences, Marcus Institute/Department of Medicine and Psychiatry, Harvard Medical School; Eva M. Schmitt, Ph.D., Aging Brain Center, Marcus Institute.
This study was funded in part by the National Institute on Aging grants no. R24AG054259 (SKI), P01AG031720 (SKI). Dr. Inouye holds the Milton and Shirley F. Levy Family Chair at Hebrew SeniorLife. Dr. Marcantonio's time was supported in part by K24AG035075; Dr. Franchesca Arias' time was supported in part by grant no. 2019-45AARFD-644816 of the Alzheimer's Association; Dr. Kind's time was supported by National Institute on Minority Health and Health Disparities Award (R01MD010243 [PI 47Kind]) and National Institute on Aging RF1AG057784 [PI Kind, MPI Bendlin].
About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Hinda and Arthur Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making. For further information on the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, please visit https://www.marcusinstituteforaging.org/.
About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Based in Boston, the nonprofit organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit http://www.hebrewseniorlife.org and our blog, or follow us on Facebook, Instagram, Twitter, and LinkedIn.
Journal of the American Geriatrics Society