Psychiatric Rehospitalization Among Elderly Persons in the United States

School of Social Work, Rutgers University, 536 George St., New Brunswick, NJ 08901-1167, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 10/2008; 59(9):1038-45. DOI: 10.1176/
Source: PubMed


This study examined predictors of psychiatric rehospitalization among elderly persons.
Readmission within six months of an index hospitalization was modeled by using Medicare data on all hospitalizations with a primary psychiatric diagnosis in the first half of 2002 (N=41,839). Data were linked with state and community-level information from the U.S. census.
Twenty-two percent of beneficiaries were rehospitalized for psychiatric reasons within six months of discharge. After the analyses adjusted for sociodemographic factors, readmission was most likely among persons with a primary diagnosis of schizophrenia (hazard ratio [HR]=2.63), followed by bipolar disorder (HR=2.51), depression (HR=1.75), and substance abuse (HR=1.38) (reference group was "other" psychiatric conditions). A baseline hospital stay of five or more days for an affective disorder was associated with a reduced readmission hazard (HR=.68, relative to shorter stays), yet the opposite was true for a nonaffective disorder (HR=1.26). For persons with nonaffective disorders, an elevated hazard of readmission was associated with comorbid alcohol dependence (HR=1.32), panic disorder (HR=1.76), borderline personality disorder (HR=2.33), and drug dependence (HR=1.17). However, for persons with affective disorders, having a personality disorder other than borderline personality disorder or dependent personality disorder (HR=1.27) and having an "other" anxiety disorder (HR=1.15) were significantly associated with an increased risk of rehospitalization. Obsessive-compulsive disorder increased the readmission hazard in both groups.
Readmission risk factors may differ for affective disorders and nonaffective disorders. Very short hospitalizations were associated with increased risk of rehospitalization among persons with an affective disorder, which underscores the need for adequate stabilization of this group of patients during hospitalization. Results also highlight the specific types of comorbidities associated most strongly with rehospitalization risk.

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    • "Clinical trials and observational studies show a significant reduction in mortality and morbidity in patients with HIV, ho have been treated with antiretroviral combination therapy (ARCT).[67891011] This reduction in mortality is clearer particularly in industrialized and high income countries where access to health services and antiretroviral treatment is readily available.[12] "
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    ABSTRACT: Predicting life expectancy is an important component of public health, in that, it may affect policy making in fields such as social security and medical care., To estimate the life expectancy and the average years of life lost (AYLL) of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-infected population, compared with that of the general population, and also to assess the impact of the CD4 count, risk factors of transmission, marital status, and employment status on life expectancy. This study is a population-based cohort study. The sample consisted of HIV/AIDS-infected patients receiving care from 2001-2011. The patients were all adults (20-64 years) who were recruited from the Counseling Center of Behavioral Diseases. Life expectancy was measured based on an abridged life table, according to age-specific mortality rates and average years of life lost (AYLL) during the study period. Forty-three of the 205 eligible patients died during 853 person-years follow-up. Compared to the general population, the life expectancy for patients with HIV infection at age 20 is about 36 years less. We have found that out a total of 1597 years of life lost during 2001-2011, compared to an overall AYLL for all HIV/AIDS, the deaths had occurred 36 years earlier than the life expectancy. Life expectancy in HIV/AIDS-infected patients is about 38 years less than that of the general population at the exact age of 20. The deaths caused by HIV/AIDS occurred about 36 years before what was expected in the general population at ages 20-64, and many of these years of life lost could be saved if the health care system was implemented against the risk factors of HIV/AIDS.
    No preview · Article · Dec 2013 · Journal of research in medical sciences
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    • "A second key finding of our study was the identification of a high-risk postdischarge period (i.e., 60┬ádays postdischarge) during which a patient has an increased risk for rehospitalization and incurs greater health care costs. Prior studies have suggested that patients with schizophrenia experiencing hospitalization had a greater likelihood of rehospitalization following hospital discharge, with the first hospitalization event being a significant predictor of the rehospitalization event [13-16]. Consequently, patients experiencing rehospitalization have approximately 5 times greater health care costs (mean: $50,986 vs. $10,352) than patients without a rehospitalization [13]. "
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    ABSTRACT: This study aimed to assess antipsychotic adherence patterns and all-cause and schizophrenia-related health care utilization and costs sequentially during critical clinical periods (i.e., before and after schizophrenia-related hospitalization) among Medicaid-enrolled patients experiencing a schizophrenia-related hospitalization. All patients aged >= 18 years with a schizophrenia-related inpatient admission were identified from the MarketScan Medicaid database (2004--2008). Adherence (proportion of days covered [PDC]) to antipsychotics and schizophrenia-related and all-cause health care utilization and costs were assessed during preadmission (182- to 121-day, 120- to 61-day, and 60- to 0-day periods; overall, 6 months) and postdischarge periods (0- to 60-day, 61- to 120-day, 121- to 180-day, 181- to 240-day, 241- to 300-day, and 301- to 365-day periods ; overall, 12 months). Health care utilization and costs (2010 US dollars) were compared between each adjacent 60-day follow-up period after discharge using univariate and multivariable regression analyses. No adjustment was made for multiplicity. Of the 2,541 patients with schizophrenia (mean age: 41.2 years; 57% male; 59% black) who were identified, approximately 89% were "discharged to home self-care." Compared with the 60- to 0-day period before the index inpatient admission, greater mean adherence as measured by PDC was observed during the 0- to 60-day period immediately following discharge (0.46 vs. 0.78, respectively). The mean PDC during the overall 6-month preadmission period was lower than during the 6-month postdischarge period (0.53 vs. 0.69; P < 0.001). Compared with the 0- to 60-day postdischarge period, schizophrenia-related health care costs were significantly lower during the 61- to 120-day postdischarge period (mean: $2,708 vs. $2,102; P < 0.001); the primary cost drivers were rehospitalization (mean: $978 vs. $660; P < 0.001) and pharmacy (mean: $959 vs. $743; P < 0.001). Following the initial 60-day period, both all-cause and schizophrenia-related costs declined and remained stable for the remaining postdischarge periods (days 121--365). Although long-term (e.g., 365-day) adherence measures are important, estimating adherence over shorter intervals may clarify the course of vulnerability to risk and enable clinicians to better design adherence/risk-related interventions. The greatest risk of rehospitalization and thus greater resource utilization were observed during the initial 60-day postdischarge period. Physicians should consider tailoring management and treatment strategies to help mitigate the economic and humanistic burden for patients with schizophrenia during this period.
    Full-text · Article · Oct 2013 · BMC Psychiatry
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    • "Understanding these factors will decrease the number of readmissions and hospital costs. It seems that those inpatients who are seeking rehospitalisation tend to repeat some of these treatmentseeking behaviors and may assist nurses in planning care [2] [4] [6] [14] [15]. "
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    ABSTRACT: Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a) What was the readmission rate? (b) What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c) What were the effective factors on readmission? Method. This cross-sectional study was conducted on a total number of 3935 patients who were admitted to Isfahan University Hospital Psychiatric Ward in Isfahan, Iran, from 2004 to 2010. Gender, age, marital status, education, self-report history of previous admission, type of psychiatric disorder, substance misuse, suicide, and the length of the current psychiatric disorder were collected from the registered medical files of patients. The data were analysed using the negative binomial regression model. Results. We found that factors such as psychiatric anxiety disorder, bipolar I, bipolar II, psychotic disorder, depression, and self report history of previous admission were statistically significant in the number of readmissions using the negative binomial model. Conclusion. Readmission to the psychiatric ward is mainly predictable by the type of diagnosis and psychosocial supports.
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