Objective: To estimate life-expectancy of psychogeriatric patients having participated in an interdisciplinary reactivation program. To identify prognostic characteristics – assessed at intake - for post-discharge survival.
Participants: Psychogeriatric patients (N/75), suffering from very mild to moderate cognitive function disorders in conjunction with psychiatric function disorders.
Design: A prospective, clinical-empirical, observational study in a psychiatric skilled nursing home.
Measurements: General, functional and diagnostic patient characteristics assessed at intake for the reactivation program; post-discharge survival rate over a period of 7 years.
Statistics: Kaplan-Meijer test for equality of survival distribution; Log Rank test to test difference of survival distribution. Cox regression analyses for identifying prognostic characteristics for postdischarge survival.
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%CI: 74 to 116) of the ‘independent’ reactivation group 35 months (95%CI: 25 to 45) and of the ‘dependent’ reactivation group 13 months (95%CI: 3 to 22). For the patients (N/75) having participated in the reactivation program gender was the only general characteristic of prognostic value for post-discharge survival (survival for women was higher; HR/3.07; 95%CI: 1.61 to 5.85). Age was statistically insignificant. One functional characteristic, the Global Deterioration Scale (cognition), was of prognostic importance (HR/1.58; 95%CI: 1.11 to 2.23). The diagnostic characteristics of prognostic importance were: psychiatric function disorders (paranoia; HR/2.19; 95%CI: 1.11 to 4.28), somatic comorbidity (urogenital pathology; HR/1.83; 95%CI: 1.13 to 2.94; cardiopulmonary pathology; HR/1.56; 95%CI: 1.16 to 2.07) and adequacy of caregiver system (HR/0.59; 95%CI: 0.33 to 1.03). The specific diagnostic classifications of cognitive function disorders (DSM-IV) were not of prognostic importance. It was possible to account for 32% of the variance of post-discharge survival.
Conclusion: The estimated probability of survival of the ‘independent’ reactivation group was obviously higher (1/HR/3.2) than that of the ‘dependent’ group. There was no overlap in 95%CI of the median post-discharge survival period. This suggests that with respect to survival the two groups of psychogeriatric patients who participated in the reactivation program differed definitely. Gender was of significant importance (women lived longer) whereas age was not. Patients characteristics on four domains (cognitive function disorders, psychiatric function disorders, somatic comorbidity and adequacy of caregiver system) were related to survival. This is of clinical interest for optimalizing the selection of patients who can profit of the reactivation program. The development of a valid prognostic instrument is a prerequisite for such optimal medical decision making. 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 2001.
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