Impact of Psychotic Disorders on Discharge Dispositions of Adults 65 or Older After a General Medical Inpatient Stay
ABSTRACT This study examined the extent to which a psychotic disorder, as well as demographic and clinical characteristics, predicted the discharge disposition of adults aged 65 or older after a hospital stay for a general medical illness.
Data from a nationally representative sample of hospital discharges among persons 65 years of age or older (N=2,334,130) were drawn from the 2007 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. A series of multivariate logistic regression models were constructed to examine the impact of psychotic disorders and demographic and clinical characteristics on four discharge dispositions--routine discharge, home care, nursing facility, or in-hospital mortality--among patients with or without a psychotic disorder.
Patients with a psychotic disorder (N=23,751) were significantly more likely than those without a psychotic disorder (N=2,310,379) to be discharged to home care (OR=1.60) or to a nursing facility (OR=4.49) or to die in the hospital (OR=1.95). Patients with a psychotic disorder were more likely than patients without a psychotic disorder to be discharged to a nursing facility if they were also male (OR=4.96), between 65 and 74 years old (OR=6.05), or admitted from another inpatient facility (OR=6.14) or if their illness was of mild or moderate severity (OR=4.87).
The significantly increased likelihood for referral to skilled home care and nursing facilities after hospital discharge among psychotic patients highlights the need for viable and dynamic community-based care options for maintaining the health and well-being of older adults with a psychotic disorder after an acute care event.
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ABSTRACT: The President's New Freedom Commission on Mental Health was created to evaluate the quality and effectiveness of the nation's mental health service delivery system, to identify unmet needs and barriers to services, and to provide recommendations on methods for improving the mental health system. A health policy analysis was prepared for the Commission examining the organization, delivery, and financing of mental health services for older Americans. The author identified three healthcare themes, including 1) access and continuity of services; 2) quality; and 3) workforce and caregiver capacity. From among these areas, 10 policy issues and recommendations were proposed.American Journal of Geriatric Psychiatry 09/2003; 11(5):486-97. DOI:10.1176/appi.ajgp.11.5.486 · 3.52 Impact Factor
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ABSTRACT: In response to the recent Olmstead decision, to compare consumer and clinician perspectives on the appropriateness of nursing home settings for older adults with severe mental illness (SMI) in relation to clinical characteristics and care needs. Cross-sectional, descriptive, correlational study. Ten community mental health centers and two state-funded nursing homes specializing in long-term care for older persons with SMI. Consumers of mental health services in the community (n=115) and in nursing homes (n=106), aged 60 and older, with SMI. Sixty-four clinicians (51% registered nurses, 29% masters-level clinicians, and 20% certified social workers) conducted ratings. Consumers and their clinicians were independently asked to determine the most appropriate care setting for each consumer based on care needs from three alternatives: nursing home, congregate (group) living setting, or individual apartment/home. Clinical characteristics of participants with SMI were rated using the Mini-Mental State Examination, Brief Psychiatric Rating Scale, Specific Level of Function Scale, Cumulative Illness Rating Scale for Geriatrics, a modified memory and orientation subscale from the Clinical Dementia Rating Scale, and an item from the Minimum Data Set related to reasoning. Of nursing home residents with SMI who did not have severe cognitive impairment, 40% (n=42) and 51% (n=54) were considered by consumers or by their clinician, respectively, to be more appropriate for a community-based setting, but there was a low level of agreement (only 27.6%; no better than chance) between consumers and clinicians on which nursing home residents were most appropriate for living in the community. Determinations by clinicians were associated with clinical need (diagnosis and less-severe behavioral problems), whereas there was no association between clinical needs and level of care determinations by consumers. Finally, clinicians considered a group home necessary for 93.7% of nursing home residents judged to be more appropriate for a community-based setting, whereas 90.5% of consumers stated that an apartment or individual home was indicated. State implementation of the Olmstead decision will need to consider major differences in perspectives between clinicians and consumers on the most appropriate long-term care setting for older persons with SMI.Journal of the American Geriatrics Society 12/2003; 51(11):1571-9. DOI:10.1046/j.1532-5415.2003.51508.x · 4.22 Impact Factor
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ABSTRACT: Medical inpatients often suffer from comorbid psychiatric illness, which has been shown in previous studies to be associated with longer hospital stays. The present analysis used a large representative dataset to examine the impact of patient demographic and clinical characteristics on the relationship between psychiatric comorbidity and hospital length of stay. Analyses showed the existence of a psychiatric comorbidity predicted longer hospital stays for medical inpatients. However, in comparison to previous research, this effect was attenuated in this sample. Patients with mental disorders who were elderly, on Medicare, and those with schizophrenia or mood disorders were especially at risk for slightly longer lengths of stay.Psychiatric Quarterly 02/2006; 77(3):203-9. DOI:10.1007/s11126-006-9007-x · 1.26 Impact Factor