Hospital stressors experienced by elderly medical inpatients: developing a Hospital Stress Index

To develop a long and short version of an index to measure experiences during hospitalization perceived by elderly patients as stressful.

Consecutive patients aged sixty or over admitted to a university teaching hospital were assessed for hospital-related stressors during two separate studies. In the first study, seventy-six patients were asked an open-ended question exploring what they found most stressful about being in the hospital. Responses were grouped into major categories, and questions were developed to address concerns in each category; the resulting forty items were called the Hospital Stress Index (HSI). The HSI was then administered to a separate group of ninety-two patients; data were also collected on functional disability (impaired ADLs), dysfunctional attitudes (DAS), and depressive symptoms (CES-D).

Spontaneously reported hospital stressors were grouped into seven categories: 1) adverse effects of diagnostic or therapeutic procedures/treatments, 2) forced life-style changes, 3) relationships with staff, 4) individual psychiatric issues, 5) understanding diagnosis/prognosis, 6) family issues, and 7) the physical environment. The largest category of stressors concerned relationships with doctors and nurses. High HSI scores were significantly more common among Whites than Blacks and among patients with high CES-D, high DAS, or impaired ADLs scores. A number of potentially modifiable hospital-related stressors and individual patient issues were identified. Finally, an abbreviated fifteen-item HSI was developed to maximize patient discriminability, highlight individual differences, and enhance the detection of modifiable stressors.

Hospital-reported stressors may contribute to the emotional distress that elderly inpatients experience. We have developed an index to identify such stressors.