Impact of psychotic disorders on discharge dispositions of adults 65 or older after a general medical inpatient stay

Abstract

Objective: This study examined the extent to which a psychotic disorder, as well as demographic and clinical characteristics, predicted the discharge disposition of adults aged 65 or older after a hospital stay for a general medical illness.

Methods: Data from a nationally representative sample of hospital discharges among persons 65 years of age or older (N=2,334,130) were drawn from the 2007 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. A series of multivariate logistic regression models were constructed to examine the impact of psychotic disorders and demographic and clinical characteristics on four discharge dispositions--routine discharge, home care, nursing facility, or in-hospital mortality--among patients with or without a psychotic disorder.

Results: Patients with a psychotic disorder (N=23,751) were significantly more likely than those without a psychotic disorder (N=2,310,379) to be discharged to home care (OR=1.60) or to a nursing facility (OR=4.49) or to die in the hospital (OR=1.95). Patients with a psychotic disorder were more likely than patients without a psychotic disorder to be discharged to a nursing facility if they were also male (OR=4.96), between 65 and 74 years old (OR=6.05), or admitted from another inpatient facility (OR=6.14) or if their illness was of mild or moderate severity (OR=4.87).

Conclusions: The significantly increased likelihood for referral to skilled home care and nursing facilities after hospital discharge among psychotic patients highlights the need for viable and dynamic community-based care options for maintaining the health and well-being of older adults with a psychotic disorder after an acute care event.