RESUMEN
OBJECTIVES: Does social isolation predict re-hospitalization in a group of older men enrolled in Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT), a mental health care-coordination project at nine Veterans Affairs Healthcare Centers nationwide? METHODS: The current study examined 123 UPBEAT patients located at West Los Angeles, whose ratings were available on the Lubben Social Network Scale (LSNS), the SF-36 scale, the Cumulative Illness Rating Scale (CIRS) and the Mental Health Index (MHI-38) Depression and Anxiety subscales. Within one year of enrollment, 55% of patients were re-hospitalized. Odds of re-hospitalization were calculated using two logistic regression models. Social isolation risk (LSNS) and demographic covariates were included. In addition, Model 1 contained depression and anxiety measures (MHI-38) and physician-rated medical burden (CIRS), while in Model 2, patient-perceived physical (PCS) and mental health (MCS) subscales from the SF-36 were included. RESULTS: The group of patients who were socially isolated or at high or moderate risk for isolation, were 4-5 times more likely to be re-hospitalized within the year, than low isolation risk patients. In both Models 1 (chi-square = 19.86; p = 0.031) and 2 (chi-square = 26.42; p = 0.002) demographic characteristics were not significant predictors of re-hospitalization, but social isolation risk was a significant predictor (Model 1: odds ratio (OR) = 5.31; 95% confidence intervals (CI) = 1.81-15.53; and Model 2: OR = 3.86; 95% CI = 1.39-10.73). In addition, MHI-Anxiety was a significant predictor (OR = 1.22; 95% CI = 1.05-1.43) in Model 1 and in Model 2, patient-perceived physical health significantly predicted re-hospitalization (OR = 0.91; 95% CI = 0.86-0.96). CONCLUSION: When controlling for other covariates, social isolation, physical health and mental health were significant risk factors for re-hospitalization. These findings underline the importance of assessing and addressing lack of social support, along with other factors, in the health care of older male veterans.
Asunto(s)
Servicios de Salud para Ancianos/organización & administración , Servicios de Salud para Ancianos/estadística & datos numéricos , Readmisión del Paciente , Aislamiento Social/psicología , Apoyo Social , Veteranos/psicología , Anciano , Predicción , Estado de Salud , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Pronóstico , Factores de RiesgoRESUMEN
BACKGROUND: The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services. OBJECTIVES: To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use. DESIGN: Randomized trial. SUBJECTS: Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). MEASURES: The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates. RESULTS: Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156). Inpatient savings were attributable to fewer bed days of care (3.30 days; P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and postenrollment hospitalizations had the greatest overall savings ($6,015; P = 0.069). CONCLUSIONS: UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improvement in mental health and general health status as usual care.
Asunto(s)
Alcoholismo/complicaciones , Alcoholismo/diagnóstico , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/diagnóstico , Continuidad de la Atención al Paciente/organización & administración , Trastorno Depresivo/complicaciones , Trastorno Depresivo/diagnóstico , Evaluación Geriátrica , Psiquiatría Geriátrica/organización & administración , Hospitales de Veteranos/estadística & datos numéricos , Tamizaje Masivo/organización & administración , Servicios de Salud Mental/organización & administración , Grupo de Atención al Paciente/organización & administración , United States Department of Veterans Affairs/estadística & datos numéricos , Anciano , Alcoholismo/terapia , Análisis de Varianza , Trastornos de Ansiedad/terapia , Comorbilidad , Análisis Costo-Beneficio , Trastorno Depresivo/terapia , Femenino , Estudios de Seguimiento , Estado de Salud , Hospitales de Veteranos/economía , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de Salud , Escalas de Valoración Psiquiátrica , Estados Unidos , United States Department of Veterans Affairs/economía , VeteranosRESUMEN
The authors describe the initial cohort of participants in the GET SMART program, an age-specific, outpatient program for older veterans with substance abuse problems. Chief among the program's services is a relapse-prevention intervention consisting of 16 weekly group sessions using cognitive-behavioral (CB) and self-management approaches. Group sessions begin with analysis of substance use behavior to determine high-risk situations for alcohol or drug use, followed by a series of modules to teach coping skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, urges (self-statements), and slips or relapses. Of the first 110 admissions, more than one-third were homeless, which is indicative of the severity of psychosocial distress of the patients, and more than one-third used illicit drugs. A total of 49 patients completed CB treatment groups and 61 dropped out of treatment. At 6-month follow-up, program completers demonstrated much higher rates of abstinence compared to noncompleters. The results suggest that CB approaches work well with older veterans with significant medical, social, and drug use problems.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastornos Relacionados con Sustancias/terapia , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Estudios de Cohortes , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Factores de Riesgo , Prevención Secundaria , Estados Unidos , Veteranos/psicologíaRESUMEN
The authors describe two case histories of patients served by the GET SMART program that provide a glimpse of typical client substance abuse histories and their remarkable journeys of change. An age-specific outpatient program for older veterans with illicit drug and alcohol dependence, the GET SMART program uses individualized and group treatment interventions in an environment of collaboration, respect, and hope. The program employs the stages of change framework and a clinical framework that includes cognitive-behavioral and motivational interviewing approaches.