Characteristics of elderly psychiatric patients retained in a state hospital during downsizing: a prospective study with replication.
OBJECTIVE
This study examined the clinical characteristics of elderly inpatients associated with retention in a large state hospital during a period of rapid reduction in the inpatient census.


METHODS
During the first year of the study all inpatients age 65 or greater were individually evaluated. Patients remaining in the hospital during the second year were reevaluated and followed for an additional year. Separate statistical analysis of the data allowed for replication of findings.


METHODS
The study was conducted at Pilgrim Psychiatric Center, the largest state hospital in New York State.


METHODS
The entire inpatient population over the age of 65 were included in the study (N = 806). The average age of the sample was 76 years and 70% were assigned a lifetime research diagnosis of schizophrenia. The majority of patients were hospitalized for long periods (mean = 33.9 years) and had significant cognitive impairment.


METHODS
Cognitive functioning was assessed on the Clinical Dementia Rating Scale. Severity of psychiatric symptoms was evaluated on the PANSS. Occurrence of dangerous behavior and medical and psychiatric treatment were obtained from the patients' medical histories.


RESULTS
The findings, replicated across assessments, were that patients retained had more severe symptoms of excitement, hostility and impulsive behavior than those discharged, while uncooperativeness, delusions, grandiosity and suspiciousness were also more severe in those retained than those discharged.


CONCLUSIONS
Elderly patients who are very difficult to place are so characterized because of behavior disorders that are difficult to manage rather than psychotic symptoms, cognitive impairment or medical disorders.
White
L
L
Mount Sinai School of Medicine, New York, New York, USA.
Parrella
M
M
McCrystal-Simon
J
J
Harvey
P D
PD
Masiar
S J
SJ
Davidson
M
M
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005852:Geriatric Psychiatry / Q000379:methods*; D006778:Hospitals, Psychiatric; D006783:Hospitals, State; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D009518:New York / Q000453:epidemiology; D010351:Patient Discharge / Q000592:standards*; D018579:Patient Selection; D011446:Prospective Studies; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000453:epidemiology; D012720:Severity of Illness Index