their families and physicians are increasingly concerned with cognitive functional and

their families and physicians are increasingly concerned with cognitive functional and psychological outcomes of chronic and acute medical conditions. Centered Outcomes Research Institute (PCORI) in 2010 2010 with an emphasis on answering questions most important to patients their caregivers and providers further increased the attention paid to patient reported outcomes by clinical outcomes researchers.2 During the same time period a ��Post-hospital syndrome�� has been described as a period of ��generalized risk�� following hospitalization when patients may experience impairments in physical psychological and cognitive function and are vulnerable to poor health outcomes seemingly unrelated to the condition for which they were hospitalized.3 The recognition and characterization of the post-hospital syndrome has further enhanced interest in characterizing the patient beyond the clinical factors contained in the medical record. In this issue of screening of cognitive and physical function in Bexarotene (LGD1069) all and particularly older patients. Since rate of development of Bexarotene (LGD1069) functional impairments changed most significantly in patients with the fewest impairments prior to hospitalization knowing the cognitive and functional status of a patient prior to an acute event would be helpful for understanding ��what to expect�� following hospitalization. In addition although there is considerable controversy regarding the benefit of cognitive screening for treatment decision making and clinical outcomes 5 6 there is also acknowledgement of changes in cognitive function during or following acute illness or hospitalization.3 7 The findings in the Levine paper suggest that cognitive changes can be expected in the years following stroke but not MI. Systematic cognitive screening and surveillance would identify patients deviating from an ��expected�� trajectory (for example development of moderate cognitive impairment in the years after an MI). Questions remain unanswered regarding whether there is temporary cognitive or physical impairment that resolves quickly after the transitional period from hospital to home but that may influence success in rehabilitation and in turn short-term outcomes (e.g. 30 readmission). Since the HRS dataset interviews are conducted every 2-years cognitive and functional Rabbit Polyclonal to HUNK. assessments were not necessarily representative of function around the time of the hospitalization including during the critical peri-discharge and hospital to home transition periods. Due to the study design the authors are unable to report time to first cognitive/functional assessment after the acute event nor how many assessments were made following the event. Both are important to understand the significance of the data. In addition since no assessments were conducted in-hospital it is not possible from the Health and Retirement Study data to examine short-term trajectories of cognitive and functional change (improvement and decline) around the time of hospitalization. Patient reported outcomes research has advanced our assessment of function beyond activities of daily living (ADLs) and instrumental activities of daily living (IADLs) dramatically in the past decade. Health related quality of life (HRQoL) measures capturing general QoL such as the SF-36 8 and disease specific QoL such as the Seattle Angina Questionnaire9 and the Disease Impact Scale are increasingly included in Bexarotene (LGD1069) Bexarotene (LGD1069) longitudinal studies of hospitalized and chronically ill patients. These HRQoL measures represent not only functional impairment but how functional impairments affect a person’s ability to engage in or maintain family social and work roles. Trajectories of general and disease specific HRQoL measures would extend the findings of Levine and colleagues and allow us to answer additional patient questions such as ��Is my heart problem (or stroke) going to limit my ability to enjoy the everyday activities I always have?��. Modern approaches to trajectory analysis such as growth mixture modeling or group-based trajectory modeling 10 have improved our ability to model complex trajectories and to identify characteristics of patients who follow a specific trajectory. Levine and colleagues modeled trajectories of average change before and after stroke and MI using multivariable conditional logistic regression.4 While appropriate this approach assumes that the trajectories experienced in the population are fairly homogeneous. However when the model.