Older adults recovering after hospitalization in an intensive care unit (ICU) are at high risk of functional decline. Older adult ICU survivors often report symptoms of cognitive impairment, sleep disturbances, and pain, which can complicate functional recovery. In addition, certain social determinants of health (SDoH) are associated with worse cognitive and physical outcomes that lead to functional decline in older adult ICU survivors. Little is known about the relationships between patient-reported symptoms (e.g., cognitive function, sleep quality, and pain intensity), selected SDoH, and functional recovery for older ICU survivors during hospitalization. This project has two overall aims: 1) explore associations between patient-reported symptoms of cognitive function, sleep quality, pain, and SDoH; and 2) explore associations between these variables and successful participation in physical therapy and/or occupational therapy (PT/OT). We collected and utilized data from two ongoing randomized controlled trials. Older ICU survivors hospitalized at University of Washington Medical Center or Harborview Medical Center were recruited and enrolled. Participants answered the PROMIS Cognitive Function Abilities, Sleep Disturbances, Sleep Related Impairment, and Pain Intensity questionnaires to evaluate self-reported cognitive function, sleep quality, and pain intensity. We did chart review of electronic health records to gather relevant information regarding SDoH, and length of PT/OT participation in minutes. We examined the differences using t-tests, Chi-squared tests, and ANOVA for binary, categorical, and/or continuous variables, respectively. We used descriptive analysis to explore trends between self-reported pain, sleep quality, and selected SDoH on self-reported cognitive function and participation in PT/OT. Results from this project will inform the design of subsequent clinical trials, which could aid in the development of personalized interventions aimed at reducing functional decline in older ICU survivors. 

Extensive research has established that certain social determinants of health (SDoH) can significantly influence health outcomes for older adults. Older adults from socioeconomically disadvantaged backgrounds often lack access to a tertiary or quaternary care hospital for complex care for severe chronic illness. Such healthcare disparities have the potential to negatively impact cognitive and mental health for older adults with chronic illnesses, particularly after intensive care unit (ICU) hospitalization. There is limited research examining the associations between SDoH, cognitive function, and mental health in older adult ICU survivors during the early post-ICU inpatient transition period. We aim to gain insight on how to best tailor inpatient interventions to suit older adult ICU survivors from disadvantaged or vulnerable backgrounds. Our project has two overall goals: 1) explore associations between SDoH, self-reported depression and anxiety, and severity of illness; and 2) explore associations between SDoH, selected objective measures of cognitive function, and severity of illness. Data from two ongoing randomized controlled trials of older adult ICU survivors enrolled from the University of Washington Medical Center or Harborview Medical Center are utilized. Participants answer the PROMIS Depression and Anxiety questionnaires to evaluate self-reported depression and anxiety symptoms. Chart review of participants’ inpatient electronic health records provides relevant information regarding SDoH, including home addresses, which provide information on census tracts towards index calculations. Other relevant clinical variables documented by inpatient healthcare providers, particularly severity of critical illness, are used for descriptive analyses. Ultimately, we anticipate that the results from this study will guide the development of future clinical trials. Possible next steps involve creating personalized interventions that integrate insights on SDoH to promote cognitive and mental health in older adult ICU survivors at high risk for cognitive decline.

Approximately 18% of older adult intensive care unit (ICU) survivors with delirium are diagnosed with Alzheimer’s disease or related dementia (ADRD) within three years of hospitalization. The constant, 24-hour ICU care can cause disruptions to sleep quality and the biological circadian rhythm. These disturbances, which affect up to 80% of ICU patients, can decrease the efficacy and benefits of interventions to manage delirium and improve cognitive function. We aim to explore the roles of individual chronotypes (morning, afternoon, or evening preference) and self-reported cognitive function on acceptability and adherence to a computerized cognitive training (CCT) intervention for older adult ICU survivors.  Data from two ongoing randomized controlled trials (the SLEEP-COG Study and OPTIMIZE Study) are utilized for this project. Older adult ICU survivors hospitalized at University of Washington Medical Center or Harborview Medical Center are enrolled based on the following eligibility criteria: ages 60 and older, functionally independent prior to hospitalization, and within 48 hours after transfer from intensive care to acute care. Participants who are randomized to CCT complete 30-minute daily sessions for up to 7 days or until discharge. Participants answer the Composite Scale of Morningness questionnaire to determine their individual chronotype and complete the PROMIS Cognitive Function & Cognitive Function Abilities instruments to examine self-reported cognitive function. Upon completion of the CCT intervention, participants answer Likert-type surveys and open-ended questions about feasibility, acceptability, and usability.  Analyses will explore trends between chronotype, self-reported cognitive function, and acceptability.  Differences will be described using t-tests, Chi-squared tests, and ANOVA for binary, categorical, and/or continuous variables, respectively. Potential future directions may include the development of personalized interventions that integrate individual chronotype and perceived cognitive ability to minimize delirium and cognitive decline associated with ADRD in older adult ICU survivors.