title: Prevalence of physical illness among psychiatric inpatients who die of natural causes.
abstract: OBJECTIVE
  The state psychiatric hospital is experiencing an increase in medically sick and aging patients who die of natural causes while hospitalized. This study explored the "medicalization" of the state hospital by examining the prevalence of medical illness and its relationship with psychiatric illness and age among state hospital psychiatric inpatients who died of natural causes--deaths that were not accidents, homicides, or suicides.
  
  
  METHODS
  A total of 179 inpatients who died of natural causes at Western State Hospital in Washington State between 1989 and 1994 were studied retrospectively through case file review. Their demographic and institutional characteristics and psychiatric diagnoses were compared with those of others treated at the hospital (N=9,258). The medical diagnoses of patients who died were analyzed by age and psychiatric condition.
  
  
  RESULTS
  The patients who died were much older than the other patients treated during the study period. Two-thirds of those who died had organic mental disorders, mostly dementia, whereas only a fifth of the other patients had these disorders. The patients who died had a mean of eight physical illnesses, with a range from none to 21. Circulatory and respiratory conditions were most prevalent, affecting half to two-thirds of patients; these conditions had high rates of comorbidity with organic mental disorders.
  
  
  CONCLUSIONS
  The characteristics of the state hospital population and the services provided are shifting in response to mental health reform and new policies on patient self-determination. Increased emphasis on medical care added to traditional psychiatric services will require increased financial and personnel resources.
authors.affiliation: Washington Institute for Mental Illness Research and Training, Department of Psychiatry and Behavioral Sciences, University of Washington, Tacoma 98498-7213, USA. sgkamara@u.washington.edu
authors.forename: S G
authors.initials: SG
authors.lastname: Kamara
authors.forename: P D
authors.initials: PD
authors.lastname: Peterson
authors.forename: J L
authors.initials: JL
authors.lastname: Dennis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006783:Hospitals, State / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000401:mortality; D012140:Respiratory Tract Diseases / Q000401:mortality; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology