Predictors of worsening condition before discharge in patients of the gerontopsychiatric hospital.

Abstract

Introduction. Hospitalization of an elderly patient in some cases may be associated with such negative phenomena as social and psychological maladjustment, a decrease in the level of daily functioning, the formation of dependence on a hospital and hospitalism. Often in clinical practice there are patients whose condition suddenly worsens just before discharge from the hospital.
 The aim of this study was to analyze the dynamics of the patient's condition in the period preceding the planned discharge from the hospital, to identify various clinical options for worsening the condition, and to search for possible predictors of this adverse event.
 Materials and methods. Were examined 181 patients of the department of geriatric psychiatry NMIC PN. V.M. Bekhterev included by the continuous method in accordance with the criteria. The main research methods were clinical-psychopathological and clinical-anamnestic.
 Results. Deterioration of condition before discharge was observed in 44.8% of the examined patients and was represented by an exacerbation of the leading mental disorder syndrome, the appearance of new symptoms, somatic decompensation, or a combination of these phenomena. Patients whose condition worsened were characterized by longer hospital stays, more medications prescribed, a higher prevalence of hospitalism and compliance violations. Somatic decompensation developed in patients with a shorter duration of mental illness and was associated with a hidden refusal to take medications, for patients with an exacerbation of symptoms of a mental disorder, irregular drug intake and abuse were more typical.
 Conclusion. Elderly patients with a long history of hospitalizations and inpatient care options have an increased risk of deterioration before discharge from the hospital, as a result of which these patients need the earliest possible involvement in rehabilitation and psychotherapeutic measures and rational psychological support at the stage of preparation for discharge.