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The benefits of psychiatric hospitalization for older nursing home residents
M E Kunik1, H Ponce, V Molinari
1Veterans Affairs Medical Center Hospital, Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA.
Objective:
To examine the demographic characteristics and treatment outcomes of nursing home residents admitted to a geropsychiatric inpatient unit.
Design:
A retrospective cohort design based on an ongoing data base effort.
Setting:
The geropsychiatric inpatient unit of the Houston Veterans Affairs Medical Center Hospital.
Participants:
All admissions to the unit from nursing homes during an 18-month period.
Measurements:
Mini-Mental State Examination, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Cohen-Mansfield Agitation Inventory, Rating Scale for Side Effects, and Global Assessment of Functioning were administered on admission and discharge.
Results:
Paired t tests comparing change scores revealed significant decreases in general psychiatric symptoms (P < .001), depression (P < .001), and agitation (P < .001); significant improvement in global functioning (P < .001); with no significant changes in cognitive status (P = .485) or side effects (P = .120). When the patients were subgrouped according to reasons for admission, paired t tests revealed decreases in violence (CMAI Factor 1; P = .000), psychosis (BPRS thought disorder scale; P = .000 and hostility subscale; P < .008), and depression (HAM-D; P = .002). Four patients were discharged to less restrictive environments, all with chronic mental illnesses.
Conclusion:
Inpatient psychiatric hospitalization significantly benefits nursing home residents with and without dementia who are admitted for severe behavior problems.