title: Characteristics associated with inpatient versus outpatient status in older adults with bipolar disorder.
abstract: OBJECTIVE
  This is an exploratory analysis of ambulatory and inpatient services utilization by older persons with type I bipolar disorder experiencing elevated mood. The association between type of treatment setting and the person's characteristics is explored within a framework that focuses upon predisposing, enhancing, and need characteristics.
  
  
  METHODS
  Baseline assessments were conducted with the first 51 inpatients and 49 outpatients 60 years of age and older, meeting criteria for type I bipolar disorder, manic, hypomanic, or mixed episode enrolled in the geriatric bipolar disorder study (GERI-BD) study. We compared participants recruited from inpatient versus outpatient settings in regard to the patients' predisposing, enabling, and need characteristics.
  
  
  RESULTS
  Being treated in an inpatient rather than an outpatient setting was associated with the predisposing characteristic of being non-Hispanic caucasian (odds ratio [OR]: 0.1; P = .005) and past history of treatment with first-generation antipsychotics (OR: 6.5; P < .001), and the need characteristic reflected in having psychotic symptoms present in the current episode (OR: 126.08; P < .001).
  
  
  CONCLUSIONS
  Ethnicity, past pharmacologic treatment, and current symptom severity are closely associated with treatment in inpatient settings. Clinicians and researchers should investigate whether closer monitoring of persons with well-validated predisposing and need characteristics can lead to their being treated in less costly but equally effective ambulatory rather than inpatient settings.
authors.affiliation: The Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. rayana@bcm.tmc.edu
authors.forename: Rayan K
authors.initials: RK
authors.lastname: Al Jurdi
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Schulberg
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Greenberg
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.forename: Ariel
authors.initials: A
authors.lastname: Gildengers
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.forename: Robert C
authors.initials: RC
authors.lastname: Young
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000523:psychology; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010045:Outpatients / Q000523:psychology; D011569:Psychiatric Status Rating Scales