Cognitive Functioning, Retirement Status, and Age: Results from the Cognitive Changes and Retirement Among Senior Surgeons Study

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Conclusion: Performance analysis of a set of standardized cognitive tasks indicates almost all practicing senior surgeons perform at or near the level of younger colleagues, as do almost half of retired senior surgeons. Summary: Nearly 20% of practicing physicians are aged >65 and >20% of adults aged >70 have some form of cognitive impairment (Plassman BL et al, Ann Intern Med 2008;144:427-34). Therefore, there is interest in detection of cognitive deficits to reduce the prevalence of aging physicians with cognitive impairment. The authors have previously shown that measures of cognitive skill, including attention, reaction time, visual learning, and memory, decline with age among surgeons but that subjective evaluation of cognitive decline does not reflect objective measures of cognitive status. In this study, as part of the Cognitive Changes in Retirement Among Senior Surgeon Study, the authors examined objective cognitive function of senior surgeons with respect to retirement status and age. The authors administered computerized cognitive tasks that assessed reaction time, visual sustained attention, memory, and visual learning to practicing and retired surgeons at annual meetings of the American College of Surgeons. There were 168 senior surgeons aged >60 years who were compared with 126 younger surgeons aged 45 to 59 years. Performance below ≥1.5 standard deviations was felt to indicate a significant difference between groups. Sixty-one percent of practicing senior surgeons performed within the range of the younger surgeons on all cognitive tasks, and 78% of practicing senior surgeons aged 60 to 64 years performed within the range of younger surgeons on all tasks. This was compared with 38% of practicing senior surgeons aged ≥70 years. Among retired senior surgeons, 45% performed within the range of younger surgeons on all tasks. No senior surgeons performed below younger surgeons on all three tasks. The task of visual learning and memory was most difficult for senior surgeons, where one-third performed below younger surgeons. However, only 3 of 168 senior surgeons performed below younger surgeons on measures of reaction time, indicating less effect on psychomotor speed by age in this group. Only 7 of 108 practicing senior surgeons performed significantly below younger surgeons on more than one task. Comment: The data indicate most senior surgeons perform at or near the level of younger surgeons in measures of memory, visual learning, reaction time, and attention. This was so even among retired surgeons and amongst almost 75% senior surgeons planning to retire within 5 years. The data suggest objective measures of cognitive function may be useful in aiding senior surgeons in their decision to retire. Given the anticipated shortfall of practicing surgeons in the work force, retention of senior surgeons with intact cognitive function may be one of many factors important in providing adequate health care services to the population in the near and intermediate future.