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Psychoendocrine concomitants in patients following a new design of a geriatric day-care unit
1Department of Clinical Neuroscience and Family Medicine, Section of Geriatric Medicine, Karolinska Institute, Huddinge Hospital and National Institute for Psychosocial Factors and Health, Unit for Care Processes and Health, Stockholm, Sweden.
Background:
Seventeen nondemented geriatric day-care attendees were subjected to a reorganized rehabilitation programme. It is suggested that increased control of and participation in the rehabilitation process might decrease psychoendocrine stress from uncertainty and passivity.
Method:
The new programme was a change from a traditional one-shift day-care into a two-shift design with two different patient sets a day. The programme was more individualized and time-efficient with written short- and long-term goals. Regular multidisciplinary case conferences were held with the patients to follow and feedback the progress of each individual patient. The patients were prospectively followed with stress markers such as prolactin, cortisol, dehydroepiandrosterone (DHA - a testosterone metabolite), estradiol, serum lipids and serum glucose.
Results:
There was significant increase in anabolic hormones (DHA, estradiol), which contrasted with a significant decrease in catabolic hormones (prolactin, cortisol) during the actual day-care period. This pattern was restored at the 24-week follow-up for estradiol and prolactin, but with a continuous increase for DHA. Serum lipids and glucose were unaffected.
Conclusions:
This study found psychoendocrine changes that might have been elicited by a reorganization of the delivery of health care in elderly and handicapped patients. Further research is needed in order to understand these changes as well as the ideal structure and content of geriatric day-care programmes from a psychophysiological point of view.