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Psychiatric disorders as main discharge diagnosis by the Portuguese oldest old from 2000 to 2014: exploring national acute inpatient admissions

Published online by Cambridge University Press:  02 October 2017

Daniela Brandão ,
Alberto Freitas ,
Constança Paúl  and
Oscar Ribeiro
Daniela Brandão*
Affiliation:
Research and Education Unit on Ageing (UNIFAI/ICBAS-UP), University of Porto, Porto, Portugal Faculty of Medicine, University of Oporto (FMUP-UP), Porto, Portugal Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
Alberto Freitas
Affiliation:
Faculty of Medicine, University of Oporto (FMUP-UP), Porto, Portugal Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
Constança Paúl
Affiliation:
Research and Education Unit on Ageing (UNIFAI/ICBAS-UP), University of Porto, Porto, Portugal Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
Oscar Ribeiro
Affiliation:
Research and Education Unit on Ageing (UNIFAI/ICBAS-UP), University of Porto, Porto, Portugal Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
*
Correspondence should be addressed to: Daniela Brandão at UNIFAI/ICBAS-UP (Research and Education Unit on Ageing) and CINTESIS-UP (Center for Health Technology and Services Research), Institute of Biomedical Sciences Abel Salazar, Department of Behavioral Sciences, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050–313 Porto, Portugal. Phone: +351 220 480 161. Email: [email protected].
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Abstract

Background:

Mental health problems have been reported as one of the principal causes of incapacity and morbidity. According to the World Health Organization approximately 15% of adults aged 60+ and over suffer from a mental disorder. In the oldest old population, a higher deterioration in the mental state is expected, which is ought to increase the risk of incidence of mental problems and use of healthcare services. The aim of this study is to examine inpatient episodes with a mental disorder coded as primary discharge diagnosis between 2000 and 2014 by patients aged 80+ in Portugal mainland.

Method:

Exploratory descriptive analyses of data regarding the number of episodes and coded diagnosis on admission were performed.

Results:

From a total of 1,837,613 inpatient episodes, 16,430 (0.9%) correspond to episodes having a psychiatric disorder as a primary discharge diagnosis. Delirium, dementia and amnestic and other cognitive disorders (60.1%), alcohol-related disorders (17.7%) and mood disorders (8.6%) were the most common diagnosis. An analysis by age group revealed that among octogenarians and nonagenarians delirium, dementia, and amnestic and other cognitive disorders were the most common diagnosis; in the centenarian group; however, these were outweighed by alcohol-related disorders.

Conclusions:

Findings from this study document the importance of neurocognitive disorders as a primary reason for hospitalization in the oldest old, but also highlights the need of paying attention to other mental disorders among this age group. Further studies should examine the prevalence of medical comorbidities in patients with mental disorders.

Keywords

oldest oldpsychiatric disordersinpatient episodes
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 5: Issue Theme: Brain Imaging , May 2018 , pp. 685 - 694
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Andreas, S. et al. (2016). Prevalence of mental disorders in elderly people: European MentDis_ICF65+ study. The British Journal of Psychiatry, 210, 125–131. doi: 10.1192/bjp.bp.115.180463CrossRefGoogle ScholarPubMed
Bergdahl, E. et al. (2005). Depression among the oldest old: the Umea 85+ study. International Psychogeriatrics, 17, 557–575. doi: 10.1017/S1041610205002267CrossRefGoogle ScholarPubMed
Birrer, R. B. and Vemuri, S. P. (2004). Depression in later life: a diagnostic and therapeutic challenge. American Family Physician, 69, 2375–2382.Google ScholarPubMed
Brayne, C. et al. (1995). Incidence of clinically diagnosed subtypes of dementia in an elderly population. Cambridge project for later life. The British Journal of Psychiatry, 167, 255–262.CrossRefGoogle Scholar
Bryant, C. (2010). Anxiety and depression in old age: challenges in recognition and diagnosis. International Psychogeriatrics, 22, 511–513. doi: 10.1017/s1041610209991785CrossRefGoogle ScholarPubMed
Busse, R. et al. (2013). Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals?. BMJ, 346, f3197. doi: 10.1136/bmj.f3197.CrossRefGoogle ScholarPubMed
Byers, A. L., Yaffe, K., Covinsky, K. E., Friedman, M. B. and Bruce, M. L. (2010). High occurrence of mood and anxiety disorders among older adults: the national comorbidity survey replication. Archives of General Psychiatry, 67, 489–96. doi: 10.1001/archgenpsychiatry.2010.35.CrossRefGoogle ScholarPubMed
Caldas de Almeida, J. (2009). Portuguese national mental health plan (2007–2016) executive summary. Mental Health in Family Medicine, 6, 233–44.Google Scholar
Chatterji, S., Byles, J., Cutler, D., Seeman, T. and Verdes, E. (2015). Health, functioning, and disability in older adults—present status and future implications. Lancet, 385,563–575. doi: 10.1016/S0140-6736(14)61462-8CrossRefGoogle ScholarPubMed
Chung, W. (2010). Psychiatric inpatient expenditures and public health insurance programmes: analysis of a national database covering the entire South Korean population. BMC Health Serv Res, 10, 263.CrossRefGoogle Scholar
Deewing, J. and Dijk, S. (2014). What is the current state of care for older people with dementia in general hospitals? a literature review. Dementia, 0, 1–19. doi: 10.1177/1471301213520172Google Scholar
Deyo, R. A., Cherkin, D. C. and Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45, 613–9.CrossRefGoogle ScholarPubMed
Directorate-General of Health (DGS). (2016). Portugal – Saúde Mental em Números – 2015. Lisboa: Direção-Geral da Saúde.Google Scholar
Emiliussen, J., Andersen, K. and Nielsen, A. S. (2017). Why do some older adults start drinking excessively late in life? results from an interpretative phenomenological study. Scandinavian Journal of Caring Sciences. doi: 10.1111/scs.12421CrossRefGoogle ScholarPubMed
Erlangsen, A., Mortensen, P., Vach, W. and Jeune, B. (2005). Psychiatric hospitalisation and suicide among the very old in Denmark: population-based register study. The British Journal of Psychiatry, 187, 43–48.CrossRefGoogle ScholarPubMed
European Commission. (2003). The European Opinion Research Group. the Mental Health Status of the European Population. Brussels: European Commission; (Eurobarometer 58.2).Google Scholar
Freitas, J. A., Lema, I. and Costa-Pereira, A. (2016). Comorbidity coding trends in hospital administrative databases. In Rocha, A. et al. (eds.), New Advances in Information Systems and Technologies, Advances in Intelligent Systems and Computing, 445. Switzerland: Springer International Publishing.Google Scholar
Fulop, G., Strain, J. J., Fahs, M. C., Schmeidler, J. and Snyder, S. (1998). A prospective study of the impact of psychiatric co-morbidity on length of stays of elderly medical-surgical inpatients. Psychosomatics, 39, 273–280.CrossRefGoogle ScholarPubMed
Gonçalves-Pereira, M. et al. (2016). Implementação em Portugal de um estudo de prevalência da demência e da depressão geriátrica: a metodologia do 10/66 dementia research group. Revista Portuguesa de Saúde Pública, 34, 134–143. doi: 10.1016/j.rpsp.2016.03.002CrossRefGoogle Scholar
Han, B. H. et al. (2017). Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005–2014. Drug and Alcohol Dependence, 170, 198–207. doi: 10.1016/j.drugalcdep.2016.11.003CrossRefGoogle ScholarPubMed
Hendrie, H. C. et al. (2012). Comorbidity profile and healthcare utilization in elderly patients with serious mental illnesses. American Journal of Geriatric Psychiatry, 21, 1267–1276. doi: 10.1097/jgp.0b013e31826d6937CrossRefGoogle Scholar
High Commissioner for Health, Health Ministry (2008). Plano Nacional de Saúde Mental 2007–2016 — Resumo Executivo. Lisboa: Coordenação Nacional para a Saúde Mental.Google Scholar
Holahan, C. J., Schutte, K. K., Brennan, P L., Holahan, C. K. and Moos, R. H. (2014). Episodic heavy drinking and 20-year total mortality among late-life moderate drinkers. Alcoholism: Clinical and Experimental Research, 38, 1432–1438.CrossRefGoogle ScholarPubMed
James, B. and Schneider, J. (2010). Increasing incidence of dementia in the oldest old: evidence and implications. Alzheimer´s Research & Therapy, 2, 9.CrossRefGoogle ScholarPubMed
Kassem, A. M. et al. (2017). Anxiety symptoms and risk of dementia and mild cognitive impairment in the oldest old women. Aging Ment Health, 10:1–9. doi: 10.1080/13607863.2016.1274370.Google Scholar
Kuerbis, A., Sacco, P. and Moore, A. (2015). Substance use and abuse. In Pachana, N. (ed.) Encyclopedia of Geropsychology (pp. 1–12). Springer Science+Business Media Singapore.Google Scholar
Lyketsos, C. G. (2000). Dementia in elderly persons in a general hospital. American Journal of Psychiatry, 157, 704–707. doi: 10.1176/appi.ajp.157.5.704CrossRefGoogle ScholarPubMed
Mateus, C. (2013). Portugal: results of 25 years of experience with DRGs. In Busse, R., Geissler, A., Quentin, W. and Wiley, M. (eds.) Diagnosis Related Groups in Europe: Moving Towards Transparency, Efficiency, and Quality in Hospitals? (pp. 381–400). England: MC Graw Hill Open University Press.Google Scholar
Moore, A. A. et al. (2005). Longitudinal patterns and predictors of alcohol consumption in the United States. American Journal of Public Health, 95, 458–464.CrossRefGoogle ScholarPubMed
National Statistical Institute of Portugal (INE). (2012). Censos - Resultados definitivos. Região Norte – 2011. Lisboa: Instituto Nacional de Estatística.Google Scholar
Nunes, B., Silva, R. D., Cruz, V. T., Roriz, J. M., Pais, J. and Silva, M. C. (2010). Prevalence and pattern of cognitive impairment in rural and urban populations from Northern Portugal. BMC Neurol, 11, 10–42.Google Scholar
Reynolds, K., Pietrzak, R., El-Gabalawy, R., Mackenzie, C. and Sarren, J. (2015). Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry, 14, 74–81.CrossRefGoogle ScholarPubMed
Ribeiro, O., Fernandes, L., Firmino, H., Simões, M. and Paúl, C. (2010). Geropsychology and psychogeriatrics in Portugal: research, education and clinical training. International Psychogeriatrics, 22, 854–863. doi: 10.1017/S1041610210000347CrossRefGoogle ScholarPubMed
Ritter, P. L., Dal Pai, D., Belmonte-de-Abreu, P. and Camozzato, A. (2016). Trends in elderly psychiatric admissions to the Brazilian public health care system. Revista Brasileira de Psiquiatria, 38, 314–317. doi: 10.1590/1516-4446-2015-1815CrossRefGoogle Scholar
Santana, I., Farinha, F., Freitas, S., Rodrigues, V. and Carvalho, A. (2015). Epidemiologia da demência e da doença de Alzheimer em Portugal: estimativas da prevalência e dos encargos financeiros com a medicação. Acta Médica Portuguesa, 28, 182–8.CrossRefGoogle Scholar
Seitz, D., Purandare, N. and Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 1025–1039. doi: 10.1017/S1041610210000608CrossRefGoogle ScholarPubMed
Sinha, S., Peach, G., Poloniecki, J. D., Thompson, M. M. and Holt, P. J. (2013). Studies using English administrative data (hospital episode statistics) to assess health-care outcomes–systematic review and recommendations for reporting. European Journal of Public Health, 23, 86–92. doi: 10.1093/eurpub/cks046CrossRefGoogle ScholarPubMed
Struble, L. M. (2016). The challenges of hospitalized older adults with psychiatric disorders. Journal of Intensive and Critical Care, 02. doi: 10.21767/2471-8505.100015CrossRefGoogle Scholar
Wancata, J., Windhaber, J., Krautgartner, M. and Alexandrowicz, R. (2003). The consequences of non-cognitive symptoms of dementia in medical hospital departments. Int J Psychiatry Med, 33, 257–271.CrossRefGoogle ScholarPubMed
Whiteford, H. A. et al. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. The Lancet, 382, 1575–1586.CrossRefGoogle ScholarPubMed
World Health Organization (2016). Mental Health and Older Adults. Fact Sheet. Geneva: World Health Organization.Google Scholar
Xavier, M., Baptista, H., Mendes, J., Magalhães, P. and Caldas-de-Almeida, J. (2013). Implementing the world mental health survey initiative in Portugal – rationale, design and fieldwork procedures. International Journal of Mental Health Systems, 7, 19.CrossRefGoogle ScholarPubMed