Abstract
The population of Hong Kong and the proportion of elderly people have been increasing rapidly. The aim of this retrospective cohort study is to determine predictive factors for psychiatric rehospitalization within 2 years among elderly patients who were discharged from psychiatric wards, in attempt to reduce their rehospitalization rate and to reintegrate them into the community. Patients aged 65 and over, who were discharged from psychiatric wards of Pamela Youde Nethersole Eastern Hospital from 1 March 2010 to 29 February 2012, were identified. Rehospitalization within 2 years after discharge was the primary outcome measure, and the time to rehospitalization was measured as the secondary outcome. Patients were subgrouped into readmitted and non-readmitted groups. Logistic regression and Cox regression analyses were applied to the potential predictive factors with odds ratios and hazard ratios obtained, respectively, for the significant findings. Kaplan-Meier survival curves were plotted for graphical representation of the study results in survival analysis. 368 individuals satisfying the study criteria were identified. The same four factors were shown to be significantly associated with rehospitalization in both multiple logistic regression and Cox regression survival analysis. Referral to other psychiatric disciplines upon discharge (p< 0.001, OR=0.325, HR=0.405) was associated with a lower rehospitalization risk and correlated to a longer time to rehospitalization. History of suicidal behaviors (p< 0.001, OR=4.906, HR=3.161), history of violent behaviors (p< 0.001, OR=5.443, HR=3.935) and greater number of previous psychiatric admissions (p< 0.001, OR=1.250, HR=1.121) were associated with a higher rehospitalization risk and predicted earlier rehospitalization. The rehospitalization rate of elderly patients was 5.2% at 1 month, 9.5% at 3 months, 15.0% at 6 months, 17.1% at 1 year, 18.8% at 1.5 year and 20.9% at 2 years.
Highlights
The population in Hong Kong and the proportion of elderly people are increasing rapidly
Despite many psychiatric readmission studies were already available in the literature, surprisingly very few of them were targeted to elderly patients only
Of all 454 discharge episodes from psychiatric wards of Pamela Youde Nethersole Eastern Hospital with patients aged 65 and over from 1 March 2010 to 29 February 2012, 368 individuals formed the study population after screening for the exclusion criteria. 77 individuals were readmitted while 291 individuals were not during the 2 year follow up period
Summary
The population in Hong Kong and the proportion of elderly people are increasing rapidly. Despite many psychiatric readmission studies were already available in the literature, surprisingly very few of them were targeted to elderly patients only. Since there are only a small number of elderly psychiatric rehospitalization studies available, studies involving elderly patents and patients of all ages (including the elderly) were reviewed. Clinical factors significantly associated with rehospitalization included: length of inpatient stay , 3,5,9,10,16,19,24,25 primary psychiatric diagnosis[4,5,8,9,11,14,18,19,21,22,24,26], presence of psychiatric comorbidities[4,17,27], presence of medical comorbidity[21,27], cognitive impairment[3,25], referral for aftercare services[6,7,29,30], history of suicidal behaviors[12], history of violence[11,25,28,31] and number of previous psychiatric admissions[7,8,15,20,25,32,33]. This study was conducted to identify risk factors in attempt to reduce rehospitalization, so mental health services could be utilized more effectively in view of of the increasing needs from the aging population
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