Psychogeriatric reactivation in a psychiatric-skilled nursing home: a clinical-empirical exploration

To identify prognostic characteristics for the probability of discharge of psychogeriatric patients with functional-psychiatric pathology, in order to optimize patient selection for the reactivation programme.

A retrospective, clinical, empirical study in a Dutch psychiatric nursing home. A group of 102 patients, consecutively enrolled in a psychogeriatric reactivation programme and who met the inclusion and exclusion criteria, was retrospectively examined. The general, functional and diagnostic characteristics were assessed at baseline.

The general characteristics of the reactivation-programme patients were not of prognostic value. However, functional characteristics (GDS, HI and ADL score) were prognostically important. In addition, diagnostic characteristics were identified within the following four domains: cognitive function disorder, functional-psychiatric pathology, an inadequate caregiver system at home, and somatic comorbidity. The prognostic value of the specific diagnostic classification of cognitive function disorders (with the exception of delirium) was irrelevant.

Reactivation seems a promising programme for frail, elderly psychogeriatric patients with functional-psychiatric pathology, but without substantial deterioration of cognitive function disorders and self-care deficits. It proved possible to make advance estimates of the probability of discharge for such patients, which is of clinical interest. Before a reliable and valid prognostic instrument can be constructed, the patients' functional and diagnostic characteristics should be prospectively assessed. Ideally, a study with a randomized, controlled, parallel group design would be used for this purpose.