Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-20T05:29:33.476Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence and influence of psychiatric comorbidity on rehabilitation outcome for older hospital inpatients

Published online by Cambridge University Press:  04 May 2011

Cathy Gluyas ,
Carmel Lum ,
Sinn Yuin Chong ,
Cynthia Borg  and
Terry P. Haines
Cathy Gluyas*
Affiliation:
Rehabilitation and Aged Care Services, Southern Health, Cheltenham, Victoria, Australia
Carmel Lum
Affiliation:
Rehabilitation and Aged Care Services, Southern Health, Cheltenham, Victoria, Australia
Sinn Yuin Chong
Affiliation:
Rehabilitation and Aged Care Services, Southern Health, Cheltenham, Victoria, Australia
Cynthia Borg
Affiliation:
Rehabilitation and Aged Care Services, Southern Health, Cheltenham, Victoria, Australia
Terry P. Haines
Affiliation:
Allied Health Clinical Research Unit, Southern Health, Cheltenham, Victoria, Australia
*
Correspondence should be addressed to: Cathy Gluyas, Aged Persons’ MHS, 1 Raymond McMahon Boulevard, Endeavour Hills, Victoria 3802, Australia. Phone: +613 97097100, Fax: +613 97097101. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The objectives of this study were to characterize the psychiatric comorbidity of a group of older subacute inpatients and then determine whether their psychiatric comorbidity affected measures of rehabilitation outcomes.

Methods: Eighty-eight older subacute inpatients were recruited for this prospective study. Psychiatric comorbidity was defined according to a participants' performance on four inventory scales: the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Brief Psychiatric Rating Scale and Health of the Nation Outcome Scale 65+. Rehabilitation outcome referred to the participants' length of stay and their performance at discharge on the EuroQol-5D health-related quality of life questionnaire and Barthel index.

Results: 68% of the participants scored in the clinical range on at least one of the four scales assessing psychiatric comorbidity at admission, with 51% in the clinical range for GDS and 32% for the GAI. The decrease in scores by the time of discharge was significant for all four scales. Linear regression analyses pointed to a trend for depressive symptoms at admission to be an influential but nonsignificant predictor of rehabilitation outcome. An interesting association was found between the length of the previous acute admission and the GDS score on admission to the subacute unit.

Conclusion: A high prevalence of psychological symptoms was identified upon admission, with a significant decrease by the time of discharge. These factors did not significantly predict the selected measures of rehabilitation outcome. Opportunities for future longitudinal research on the prevalence and impact of psychiatric comorbidities on patient outcomes are considered.

Keywords

psychogeriatricmental healthsubacutegeriatricdepressionanxiety
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 9 , November 2011 , pp. 1502 - 1514
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

AMOCN (Australian Mental Health Outcomes and Classification Network) (2007–2008). http://wdst.amhocn.orgGoogle Scholar
Anderson, S. W., Crist, A. J. and Payne, N. (2004). Predicting inpatient length of stay with the expanded version of the Brief Psychiatric Rating Scale (version 4.0). Psychiatric Services, 55, 77–79.CrossRefGoogle ScholarPubMed
Bryant, C., Jackson, H. and Ames, D. (2009). Depression and anxiety in medically unwell older adults: prevalence and short-term course. International Psychogeriatrics, 21, 754–763.CrossRefGoogle ScholarPubMed
Burgess, P., Trauer, T., Coombs, T., McKay, R and Pirkis, J. (2009). What does “clinical significance” mean in the context of the Health of the Nation Outcome Scales? Australasian Psychiatry, 117, 141–148.CrossRefGoogle Scholar
Burns, A. et al. (1999). Health of the Nation Outcome Scales for Elderly People (HoNOS65+). British Journal of Psychiatry, 174, 424–427.CrossRefGoogle Scholar
Burns, A., Lawlow, B. and Craig, S. (2002). Rating scales in old age psychiatry. British Journal of Psychiatry, 180, 161–167.CrossRefGoogle ScholarPubMed
Cullum, S., Metcalfe, C., Todd, C. and Brayne, C. (2008). Does depression predict adverse outcomes for older medical inpatients? A prospective cohort study of individuals screened for a trial. Age and Aging, 37, 690–695.CrossRefGoogle ScholarPubMed
CRAFT (Casemix Rehabilitation and Funding Tree) (2009). Department of Health, Victoria, Australia. www.health.vic.gov.au/casemix/definitionsGoogle Scholar
Dolan, P. (1997). Modelling valuations for EuroQol health states. Medical Care, 35, 1095–1108.CrossRefGoogle ScholarPubMed
Denti, L., Agosti, M. and Franceschini, M. (2008). Outcome predictors for rehabilitation for first stroke in the elderly. European Journal of Rehabilitation, 44, 3–11.Google ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician”. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fulop, G., Strain, J. J., Fahs, M. C., Schmeidler, J. and Snyder, S. (1998). A prospective study of the impact of psychiatric comorbidity on length of hospital stays of elderly medical-surgical inpatients. Psychosomatics, 38, 273–280.CrossRefGoogle Scholar
Galynker, I. et al. (2000). Psychiatric symptom severity and length of stay on an intensive rehabilitation unit. Psychosomatics, 41, 114–120.CrossRefGoogle Scholar
Givens, J. L., Sanft, T. B. and Marcantionio, E. R. (2008). Functional recovery after hip fracture: The combined effects of depressive symptoms, cognitive impairment and delirium. Journal of the American Geriatrics Society, 56, 1075–1079.CrossRefGoogle ScholarPubMed
Givens, J. L., Jones, R. N. and Inouye, S. K. (2009). The overlap syndrome of depression and delirium in older hospitalized patients. Journal of the American Geriatrics Society, 57, 1347–1353.CrossRefGoogle ScholarPubMed
Glozier, N., Hackett, M. L., Parag, V. and Anderson, C. S. (2008). The influence of psychiatric morbidity on return to paid work after stroke in younger adults. Stroke, 39, 1526–1532.CrossRefGoogle ScholarPubMed
Hershkovitz, A., Kalandariov, Z., Hermush, V., Weiss, R. and Brill, S. (2007). Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Archives of Physical Medicine and Rehabilitation, 88, 916–921.CrossRefGoogle ScholarPubMed
Lenze, E. J. et al. (2007). Does depression, apathy or cognitive impairment reduce the benefit of inpatient rehabilitation facilities for elderly hip fracture patients? General Hospital Psychiatry, 29, 141–146.CrossRefGoogle ScholarPubMed
Leucht, S. et al. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry, 187, 366–371.CrossRefGoogle ScholarPubMed
Mahoney, F. I. and Barthel, D. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 56–61.Google ScholarPubMed
Menzel, J. C. (2008). Depression in the elderly after traumatic brain injury: a systematic review. Brain Injury, 22, 375–380.CrossRefGoogle ScholarPubMed
Nuyen, J., Spreeuwenberg, P. M., Groenewegen, P. P., van de Bos, G. A. M. and Schellevis, F. G. (2008). Impact of pre-existing depression on length of stay and discharge destination among patients hospitalized for acute stroke. Stroke, 39, 132–138.CrossRefGoogle Scholar
Overall, J. and Gorham, D. (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.CrossRefGoogle Scholar
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics, 19, 123–114.CrossRefGoogle ScholarPubMed
PASW (Predictive Analytics SoftWare) (2009). Statistics 17.0.3 – September 2009, www.spss.com.Google Scholar
Ponsford, J., Hill, B., Karamitsios, M. and Bahar-Fuchs, A. (2008). Factors influencing outcome after orthopedic trauma. Journal of Trauma, 64, 1001–1009.Google ScholarPubMed
Rabin, R. and de Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol Group. Annals of Medicine, 33, 337–343.CrossRefGoogle ScholarPubMed
Rubin, D. (1996). Multiple imputation after 18+ years. Journal of the American Statistical Association, 91, 473–489.CrossRefGoogle Scholar
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165–171.Google Scholar
Trauer, T. (2008). Are HoNOS scores related to length of stay in acute inpatient units? Australian and New Zealand Journal of Psychiatry, 42 (Suppl. 4), A10.Google Scholar
Yohannes, A. M., Baldwin, R. C. and Connolly, M. J. (2008). Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care. International Journal of Geriatric Psychiatry, 23, 1141–1147.CrossRefGoogle ScholarPubMed