Factors precluding patients' discharge to the community. A geropsychiatric hospital survey

Study subjects were the 206 inpatients at a 210-bed university-affiliated, state-operated geropsychiatric hospital in July 1993. Staff psychiatrists, using the behavioral component of the Agitation Behavior Mapping Instrument (ABMI) and a nonbehavioral component added by the authors, determined reasons why their patients could not return to the community at the time of the study. Aggression, nonbehavioral problems, and inability to care for self accounted for three-quarters of the primary reasons precluding immediate community placement. Of these three reasons, aggressive behavior was both the most common and the most correctable factor keeping subjects in the hospital. Aggressive behavior occurred most commonly among psychotic patients, intermediate among demented patients and least commonly among patients with mood disorders. The authors suggest the need to better define those aggressive behaviors and to develop effective treatments that can be transported with patients as they return to the community.