Effectiveness of a psychosomatic day hospital treatment for the elderly: a naturalistic longitudinal study with waiting time before treatment as control condition.
OBJECTIVE
In 2006 the psychosomatic day hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany. The aim of this study was to determine treatment effectiveness and identify possible effects on health care utilization.


METHODS
Designed as a naturalistic study with waiting time before admission as a control condition, the primary outcome was the level of depressive symptoms as measured by the hospital anxiety and depression scale. Secondary outcomes were depressive and somatoform symptoms and syndromes as measured with the patient health questionnaire, patient perception of interpersonal problems and health care use before and after treatment.


RESULTS
After treatment significant improvement (p<0.01) with moderate effect sizes (ES) was found in all variables from admission to discharge (ES from 0.3 to 0.8) and also to follow-up (ES from 0.2 to 0.6). Improvement remained stable at follow-up. Furthermore, after psychosomatic treatment a reduction in medical service usage was visible. Number of consultations (pre: 13, post: 9), number and length of hospital stays (pre: 1, 7 weeks, post: 0, 3 weeks) were both significantly (p<0.001) reduced six months after treatment as compared to the period six months prior to treatment.


CONCLUSIONS
Results indicate that the psychosomatic day hospital treatment of the elderly is successful. Reduced usage of health care and the lower costs for day hospital treatment compared to inpatient treatment point to a positive cost-effect-ratio. Expanding this psychosomatic intervention would be useful in reducing the current gap in mental health care for the elderly.
Dept. of Psychosomatic Medicine and Psychotherapy, General Hospital Nuremberg, Germany. Electronic address: christina.wunner@klinikum-nuernberg.de.
Christina
C
Wunner
Dept. of Psychosomatic Medicine and Psychotherapy, General Hospital Nuremberg, Germany.
Corinne
C
Reichhart
University Medical Centre Jena, Institute for Psychosocial Medicine and Psychotherapy, Germany.
Bernhard
B
Strauss
Dept. of Psychosomatic Medicine and Psychotherapy, General Hospital Nuremberg, Germany.
Wolfgang
W
Söllner
D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003631:Day Care, Medical / Q000379:methods*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005858:Germany; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D016896:Treatment Outcome
Day hospital; Effectiveness; Gerontology; Health care utilization; Psychosomatic medicine; Psychotherapy