Impact of Psychotic Disorders on Discharge Dispositions of Adults 65 or Older After a General Medical Inpatient Stay
Abstract
Objective:
This study examined the extent to which a psychotic disorder, as well as demographic and clinical characteristics, predicted the discharge disposition of adults aged 65 or older after a hospital stay for a general medical illness.
Methods:
Data from a nationally representative sample of hospital discharges among persons 65 years of age or older (N=2,334,130) were drawn from the 2007 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. A series of multivariate logistic regression models were constructed to examine the impact of psychotic disorders and demographic and clinical characteristics on four discharge dispositions—routine discharge, home care, nursing facility, or in-hospital mortality—among patients with or without a psychotic disorder.
Results:
Patients with a psychotic disorder (N=23,751) were significantly more likely than those without a psychotic disorder (N=2,310,379) to be discharged to home care (OR=1.60) or to a nursing facility (OR=4.49) or to die in the hospital (OR=1.95). Patients with a psychotic disorder were more likely than patients without a psychotic disorder to be discharged to a nursing facility if they were also male (OR=4.96), between 65 and 74 years old (OR=6.05), or admitted from another inpatient facility (OR=6.14) or if their illness was of mild or moderate severity (OR=4.87).
Conclusions:
The significantly increased likelihood for referral to skilled home care and nursing facilities after hospital discharge among psychotic patients highlights the need for viable and dynamic community-based care options for maintaining the health and well-being of older adults with a psychotic disorder after an acute care event. (Psychiatric Services 63:333–337, 2012; doi: 10.1176/appi.ps.201100332)