Measuring medical burden using CIRS in older veterans enrolled in UPBEAT, a psychogeriatric treatment program: a pilot study.
BACKGROUND
A quantitative measure of medical burden is needed to assess medical comorbidities in psychogeriatric patients. The Cumulative Illness Rating Scale (CIRS) is the most widely used instrument for measuring medical burden in psychogeriatric research. Many clinicians, however, are discouraged by the requirement to project the persistence of acute conditions and therefore do not use the scale. The goal of this pilot study was to determine whether the inclusion of acute medical conditions undermines the usefulness of the CIRS. No such comparison was found in the existing literature.


METHODS
Included in this study were 95 patients previously enrolled in the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) demonstration program. All were male veterans of the U.S. armed forces who were admitted to acute medical or surgical inpatient units and who had positive screening results for anxiety, depression, or alcohol abuse. Two types of retrospective CIRS ratings were made for each patient: one included (CIRS-IP) and the other excluded (CIRS-PH) acute conditions. For each type of rating (CIRS-IP and CIRS-PH), 7 CIRS scores were computed according to methods reported in the literature. Survival time during 24 months of follow-up was used as a measure of health outcome indicating medical burden.


RESULTS
With 1 exception, CIRS-IP and corresponding CIRS-PH scores were highly correlated (.70 < r <.99; p <.001). And, for 5 of 7 scores, both CIRS-IP and CIRS-PH were significantly associated with survival time (p <.05).


CONCLUSIONS
Results suggest that the CIRS can be used as an indicator of medical burden even with the inclusion of acute conditions. If replicated, these findings may increase CIRS use and thus aid the effort to encourage clinicians working with psychogeriatric patients to use standardized instruments to document medical burden.
Mistry
Ritesh
R
Department of Psychiatry and Biobehavioral Sciences, and Neuropsychiatric Institute and Hospital, University of California, Los Angeles, USA. riteshm@ucla.edu
Gokhman
Izabella
I
Bastani
Roshan
R
Gould
Robert
R
Jimenez
Elvira
E
Maxwell
Annette
A
McDermott
Charles
C
Rosansky
Joel
J
Van Stone
William
W
Jarvik
Lissy
L
D000208:Acute Disease / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D001007:Anxiety / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D015897:Comorbidity; D017281:Cost of Illness; D003863:Depression / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D005853:Geriatrics / Q000379:methods; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010865:Pilot Projects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011613:Psychotherapy; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data