Outcome of admission to an acute psychiatric facility for older people: A pluralistic evaluation

Abstract

In this pilot study we sought to find brief, usable, reliable and valid measures of outcome from a variety of viewpoints for older adults admitted to hospital with depression or dementia. We examined patients', carers', primary nurses', consultants' and general practitioners' perceptions of outcome using a variety of measures. For the depressed patients we used nurse-rated change on the Montgomery Asberg Depression Rating Scale (MADRS) as the main outcome measure. Adequate data for analysis were collected on 24 depressed and 16 demented patients. In the depressed group there was a highly significant improvement on the MADRS. Factor analysis of the scales used produced four factors. The MADRS and the depression subscale of the Hospital Anxiety Depression (HAD-D) were strongly weighted on the first factor, the GPs' linear analogue scale on the second, the Selfcare-D (and the HAD-D) on the third and the anxiety subscale of the HAD (HAD-A) on the fourth. The HAD, which is brief and easy to use, and the GPs' linear analogue are suggested for further evaluation as routine outcome measures for depressed elderly people. For demented patients carers' rating of resolution of perceived problems is tentatively suggested for further investigation.