Clinical Characteristics and Length of Hospital Stay among Older Adults with Bipolar Disorder,Schizophrenia or Schizoaffective Disorder,Depression,and Dementia

Abstract

Although many older adults with serious psychiatric illnesses share common concerns, such as medical comorbidity, personal loss, greater propensity for adverse medication effects, and greater dependence on others for basic needs such as transportation, individualized treatment needs must be differentiated by underlying psychiatric disorders. This retrospective study evaluated clinical characteristics and resource use among 137 older adults with bipolar disorder, schizophrenia or schizoaffective disorder, depression, and dementia who were discharged from an urban, academic medical center’s inpatient geropsychiatric unit. The authors found women to be significantly overrepresented among individuals with schizophrenia or schizoaffective disorder compared to those with bipolar disorder, depression, and dementia (P= .034). Among those with bipolar disorder, anticonvulsant medications were predominantly used as mood stabilizers, with only the rare use of lithium. Individuals with schizophrenia or schizoaffective disorder were the youngest group of patients; individuals with dementia were the oldest group (P< .001). This shows significant differences in clinical characteristics among hospitalized older adults with serious mental illnesses. Additional studies are needed on outcomes of serious chronic psychiatric illnesses in later life to optimize care environments for older adult psychiatric patients.

Keywords

bipolar disorder schizophrenia depression dementia elderly geriatric health services antipsychotic medications anticonvulsants antidepressants

Get full access to this article

View all access options for this article.

References

1. Schultz SK , Miller DD , Oliver SE , et al. The life course of schizophrenia: age and symptom dimensions. Schizophr Res 1997; 23:15-23.

2. Cassano GB , Melroy SL , Brady K , et al. Current issues in the identification and management of bipolar spectrum disorders in “special populations.” J Affective Disord 2000; 59(suppl 1):S69-S79.

3. Jeste DV . Growing disparity between need and reality: research in geriatric psychiatry. Curr Opin Psychiatry 1996; 9:279-280.

4. Palmer BW , Heaton SC , Jeste DV . Older patients with schizophrenia: challenges in the coming decades. Psychiatr Serv 1999; 50(9):1178-1183.

5. Davidson M , Harvey P , Powchik P , et al. Severity of symptoms in chronically institutionalized geriatric schizophrenic patients. Am J Psychiatry 1995; 152(2):197-207.

6. Sajatovic M , Popli A , Semple W . Ten-year use of hospital-based services by geriatric veterans with schizophrenia and bipolar disorder. Psychiatr Serv 1996; 47(9):961-965.

7. Lindamer LA , Lohr JB , Harris MJ , et al. Gender-related clinical differences in older patients with schizophrenia. J Clin Psychiatry 1999; 60(1):61-67.

8. Solokangas RK . First-contact rate for schizophrenia in community psychiatric care: consideration of the oestrogen hypothesis. Eur Arch Psychiatry Clin Neurosci 1993; 242;337-346.

9. Seeman M. Current outcome in schizophrenia: women vs men. Acta Psychiatr Scand 1986; 73:609-617.

10.

10. Spicer CC , Hare EH , Slater D . Neurotic and psychotic forms of depressive illness: evidence from age-incidence in a national sample. Br J Psychiatry 1973; 123:535-541.

11.

11. Sibisi CDT . Sex differences in the age of onset of bipolar affective illness. Br J Psychiatry 1990; 156:842-845.

12.

12. Patterson TL , Jeste DV . The potential impact of the baby boom generation on substance abuse among elderly persons. Psychiatr Serv 1999; 50(9):1184-1185.

13.

13. Evans D . Bipolar disorder: diagnostic challenges and treatment considerations. J Clin Psychiatry 2000; 61(suppl 13):26-31.

14.

14. Jeste DV , Gladsjo JA , Lindamer LA , et al. Medical comorbidity in schizophrenia. Schizophr Bull 1996; 22:413-430.

15.

15. Simpson JC , Tsuang MT . Mortality among patients with schizophrenia. Schizophr Bull 1996; 22:485-499.

16.

16. Harris EC , Barraclough B . Excess mortality of mental disorder. Br J Psychiatry 1998; 173:11-54.

17.

17. Fuller MA , Sajatovic M. Drug information handbook for psychiatry. Cleveland, OH: Lexi-Comp, 1999.

18.

18. Edell WS , Tunis SL . Antipsychotic treatment of behavioral and psychological symptoms of dementia in geropsychiatric inpatients. Am J Geriatr Psychiatry 2001; 9(3):289-297.

19.

19. Madhusoodanan S , Brenner R , Cohen CI . Role of atypical antipsychotics in the treatment of psychosis and agitation associated with dementia. Cent Nerv Syst Drugs 1999; 12(2):135-150.

20.

20. Narayan M , Nelson JC . Treatment of dementia with behavioral disturbance using divalproex or a combination of divalproex and a neuroleptic. J Clin Psychiatry 1997; 58(8):351-354.

21.

21. Lott AD , McElroy SL , Keys MA . Valproate in the treatment of behavioral agitation in elderly patients with dementia. J Neuropsychiatry Clin Neurosci 1995; 7(3):314-319.

22.

22. Sajatovic M , Donenwirth K , Sultana D , Buckley P. Admissions, length of stay and medication use among women in an acute care state psychiatric facility. Psychiatr Serv 2000; 51(10):1278-1281.

23.

23. Almeida OP , Howard RJ , Levy R , David AS . Psychotic states arising in late life (late paraphrenia). The role of risk factors. Br J Psychiatry 1995; 166:215-228.

24.

24. Kulkarni J , Riedel A , de Castella AR , et al. Estrogen—a potential treatment for schizophrenia. Schizophr Res 2001; 48(1):137-144.

25.

25. Casey DE , Daniel DG , Wassef AA , Tracy KA , Wozniak P , Sommerville KW . Effect of divalproex combined with olanzapine or risperidone in patients with an acute excacerbation of schizophrenia. Neuropsychopharmacology 2003, 28, 182-189.

26.

26. Goldberg JF . Treatment guidelines: current and future management of bipolar disorder. J Clin Psychiatry 2000; 61(suppl 13):12-18.

27.

27. McDonald WM . Epidemiology, etiology, and treatment of geriatric mania. J Clin Psychiatry 2000; 61(suppl 13):3-11.

28.

28. Foster JR . Use of lithium in elderly psychiatric patients: a review of the literature. Lithium 1992; 3:77-93.

29.

29. Levine J , Chengappa KN , Brar JS , et al. Psychotropic drug prescription patterns among patients with bipolar I disorder. Bipolar Disord 2000;2(2):120-130.

30.

30. National Association of Psychiatric Health Systems . NAPHS 2001 annual survey report—trends in behavioral healthcare. Washington, DC: National Association of Psychiatric Health Systems, 2001.