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Associations of medical comorbidity, psychosis, pain, and capacity with psychiatric hospital length of stay in geriatric inpatients with and without dementia

Published online by Cambridge University Press:  21 October 2014

Zahinoor Ismail ,
Tamara Arenovich ,
Robert Granger ,
Charlotte Grieve ,
Peggie Willett ,
Scott Patten  and
Benoit H Mulsant
Zahinoor Ismail*
Affiliation:
Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Tamara Arenovich
Affiliation:
Clinical Research Department, Centre for Addiction and Mental Health, Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
Robert Granger
Affiliation:
Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
Charlotte Grieve
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ontario, Canada
Peggie Willett
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ontario, Canada
Scott Patten
Affiliation:
Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Benoit H Mulsant
Affiliation:
Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
*
Correspondence should be addressed to: Zahinoor Ismail, Clinical Associate Professor of Psychiatry and Neurology, Hotchkiss Brain Institute, University of Calgary1403–29 Street NW, Calgary, Alberta, T2N 2T9, Canada. Phone: +403-944-1110; Fax: +403-283-4794. Email: zahinoor@gmail.com.
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Abstract

Background:

Geriatric psychiatry hospital beds are a limited resource. Our aim was to determine predictors of hospital length of stay (LOS) for geriatric patients with dementia admitted to inpatient psychiatric beds.

Methods:

Admission and discharge data from a large urban mental health center, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the resident assessment instrument - mental health (RAI-MH), an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 169 geriatric patients with dementia were compared with 308 geriatric patients without dementia. Predictors of hospital LOS were determined using a series of general linear models.

Results:

A diagnosis of dementia did not predict a longer LOS in this geriatric psychiatry inpatient population. The presence of multiple medical co-morbidities had an inverse relationship to length of hospital LOS – a greater number of co-morbidities predicted a shorter hospital LOS in the group of geriatric patients who had dementia compared to the without dementia study group. The presence of incapacity and positive psychotic symptoms predicted longer hospital LOS, irrespective of admission group (patients with dementia compared with those without). Conversely, pain on admission predicted shorter hospital LOS.

Conclusions:

Specific clinical characteristics generally determined at the time of admission are predictive of hospital LOS in geriatric psychiatry inpatients. Addressing these factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.

Keywords

geriatric psychiatryhospital length of stayLOSinpatientpredictorsdementiamedical burden
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 2 , February 2015 , pp. 313 - 321
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Aisen, P. S., Giblin, K. E., Packer, L. S. and Lawlor, B. A. (1994). Determinants of length of stay in geropsychiatry. The American Journal of Geriatric Psychiatry, 2, 165–168.Google Scholar
Ashley, R. V. et al. (2001). Changes in psychiatric diagnoses from admission to discharge: review of the charts of 159 patients consecutively admitted to a geriatric psychiatry inpatient unit. General Hospital Psychiatry, 23, 3–7.CrossRefGoogle ScholarPubMed
Blais, M. A. et al. (2003). Predicting length of stay on an acute care medical psychiatric inpatient service. Administration and Policy in Mental Health, 31, 15–29.Google Scholar
Blank, K., Hixon, L., Gruman, C., Robison, J., Hickey, G. and Schwartz, H. I. (2005). Determinants of geropsychiatric inpatient length of stay. The Psychiatric Quarterly, 76, 195–212.Google Scholar
Chung, W., Oh, S.-M., Suh, T., Lee, Y. M., Oh, B. H. and Yoon, C.-W. (2010). Determinants of length of stay for psychiatric inpatients: analysis of a national database covering the entire Korean elderly population. Health Policy, 94, 120–128.Google Scholar
Connolly, S. and O’Shea, E. (2013). The impact of dementia on length of stay in acute hospitals in Ireland. Dementia, Epublished ahead of print, doi:10.1177/1471301213506922.Google Scholar
Draper, B., Karmel, R., Gibson, D., Peut, A. and Anderson, P. (2011). The hospital dementia services project: age differences in hospital stays for older people with and without dementia. International Psychogeriatrics, 23, 1649–1658.Google Scholar
Draper, B. and Luscombe, G. (1998). Quantification of factors contributing to length of stay in an acute psychogeriatrics ward. International Journal of Geriatric Psychiatry, 13, 1–7.Google Scholar
Hirdes, J. P., Frijters, D. H. and Teare, G. F. (2003). The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people. Journal of the American Geriatrics Society, 51, 96–100.Google Scholar
Hirdes, J. P. et al. (1999). Integrated health information systems based on the RAI/MDS series of instruments. Healthcare Manage Forum, 12, 30–40.CrossRefGoogle ScholarPubMed
Ismail, Z. et al. (2012). Predicting hospital length of stay for geriatric patients with mood disorders. Canadian Journal of Psychiatry, 57, 696–703.Google Scholar
Jones, R. N. et al. (2010). Aging, brain disease, and reserve: implications for delirium. The American Journal of Geriatric Psychiatry, 18, 117–127.Google Scholar
Kelly, M., Dunbar, S., Gray, J. E. and O’Reilly, R. L. (2002). Treatment delays for involuntary psychiatric patients associated with reviews of treatment capacity. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 47, 181–185.Google Scholar
Lyketsos, C. G., Dunn, G., Kaminsky, M. J. and Breakey, W. R. (2002). Medical comorbidity in psychiatric inpatients: relation to clinical outcomes and hospital length of stay. Psychosomatics, 43, 24–30.Google Scholar
Malyuk, R. E., Wong, C., Buree, B., Kang, A. and Kang, N. (2012). The interplay of infections, function and length of stay (LOS) in newly admitted geriatric psychiatry patients. Archives of Gerontolology and Geriatrics, 54, 251–255.CrossRefGoogle ScholarPubMed
Parks, E. D. and Josef, N. (1997). A retrospective study of determinants of length of stay in a geropsychiatric state hospital. Psychiatric Quarterly, 68, 91.Google Scholar
Poss, J. et al. (2008). A review of evidence on the reliability and validity of minimum data set data. Healthcare Management Forum, 21, 33–39.Google Scholar
Reeves, R. R., Parker, J. D., Burke, R. S. and Hart, R. H. (2010). Inappropriate psychiatric admission of elderly patients with unrecognized delirium. Southern Medical Journal, 103, 111–115.Google Scholar
Saravay, S. M. et al. (2004). How do delirium and dementia increase length of stay of elderly general medical inpatients? Psychosomatics, 45, 235–242.CrossRefGoogle ScholarPubMed
Smith, T. F. and Hirdes, J. P. (2009). Predicting social isolation among geriatric psychiatry patients. International Psychogeriatrics, 21, 50–59.Google Scholar
Snowdon, J. (1993). How many bed-days for an area's psychogeriatric patients? Australian and New Zealand Journal of Psychiatry, 27, 42–48.Google Scholar
Wancata, J., Windhaber, J., Krautgartner, M. and Alexandrowicz, R. (2003). The consequences of non-cognitive symptoms of dementia in medical hospital departments. International Journal of Psychiatry in Medicine, 33, 257–271.CrossRefGoogle ScholarPubMed
Zubenko, G. S., Rosen, J., Sweet, R. A., Mulsant, B. H. and Rifai, A. H. (1992). Impact of psychiatric hospitalization on behavioral complications of Alzheimer's disease. The American Journal of Psychiatry, 149, 1484–1491.Google Scholar