Life expectancy following psychogeriatric reactivation. Identification of prognostic characteristics of survival assessed on admission.
OBJECTIVE
To estimate life expectancy of psychogeriatric patients having participated in a reactivation program. To identify prognostic characteristics - on admission - for survival after discharge.


METHODS
A prospective, clinical-empirical observational study.


METHODS
A Dutch psychiatric-skilled nursing home.


METHODS
Psychogeriatric patients (n = 75) suffering from very mild to moderate cognitive function disorders in conjunction with psychiatric function disorders.


METHODS
Interdisciplinary reactivation program.


METHODS
General, functional and diagnostic patient characteristics assessed on admission for the psychogeriatric reactivation program, and survival rate after discharge over a period of 7 years.


RESULTS
The probability of survival for patients who were discharged from the psychogeriatric reactivation program to their own homes or to a residential home with restricted support ('independent' group, n = 53) was higher (1/HR = 3.2) than for patients who were discharged to a nursing home ('dependent' group, n = 22). The median survival period of the reference group (community-dwelling elderly people) was 95 months (95% confidence interval, CI: 74-116), that of the 'independent' group 35 months (95% CI: 25-45) and that of the 'dependent' group 13 months (95% CI: 3-22). For the reactivated patients (n = 75), gender was the only general characteristic of prognostic value for survival after discharge (the survival rate for women was higher; hazard ratio (HR) = 3.07; 95% CI: 1.61-5.85). Age was statistically insignificant. One functional characteristic, the Global Deterioration Scale, was of prognostic significance (HR = 1.58; 95% CI: 1.11-2.23). The diagnostic characteristics of prognostic significance were: psychiatric function disorders (paranoia; HR = 2.19; 95% CI: 1.11-4.28), somatic comorbidity (urogenital pathology; HR = 1.83; 95% CI: 1.13-2.94; cardiopulmonary pathology; HR = 1.56; 95% CI: 1.16-2.07) and adequacy of the caregiver system (HR = 0.59; 95% CI: 0.33-1.03). The specific diagnostic classifications of cognitive function disorders (DSM-IV) were not of prognostic significance. It was possible to account for 32% of the variance in survival after discharge.


CONCLUSIONS
The survival rate of the 'independent' group of patients was obviously higher (1/HR = 3.2) than that of the 'dependent' group. There was no overlap in the 95% CI of the median survival period after discharge. The results suggest that with respect to survival the two groups of psychogeriatric patients who participated in the intensive reactivation program differed definitely. Additionally, patients belonging to the 'independent' group had a greater chance to benefit from a reactivation program. The program should pay special attention to the patient characteristics on admission, which demonstrated a significant negative correlation to survival. These patient characteristics belonged to five domains (i.e. gender, cognitive function disorders, psychiatric function disorders, somatic comorbidity and adequacy of the caregiver system) The five dimensions are of clinical interest for optimizing the selection of patients who may derive most benefit from a reactivation program. The development of a valid prognostic instrument is a prerequisite for optimal medical decision-making for such intensive intervention programs, as is the analysis of cost-effectiveness. In order to draw firm conclusions, it is recommended that a large-scale study with a randomized, parallel-group design will be performed. Our group has started such a research program in July 2001.
Bakker
T J E M
TJ
Psychiatric-Skilled Nursing Home 'DrieMaasStede', Schiedam, The Netherlands. tjembakker@zorggroepwaterwegnoord.nl
Duivenvoorden
H J
HJ
van der Lee
J
J
Schudel
W J
WJ
D000368:Aged; D003704:Dementia / Q000523:psychology / Q000534:rehabilitation; D004046:Dietetics; D005260:Female; D005853:Geriatrics; D006801:Humans; D008017:Life Expectancy; D008297:Male; D001523:Mental Disorders / Q000401:mortality* / Q000451:nursing / Q000534:rehabilitation*; D009788:Occupational Therapy; D010348:Patient Care Team; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011613:Psychotherapy; D012044:Regression Analysis; D012866:Skilled Nursing Facilities; D013070:Speech Therapy; D016019:Survival Analysis