Determining Length of Inpatient Mental Health Stay for Elderly

Community psychological services address a range of emotional and behavioral needs. For the elderly, these services are especially critical because geriatric inpatient mental health care is limited. Therefore, it is imperative that the risk factors that lead to inpatient care and lengthen time of stay be identified and attended to as early as possible. Zahinoor Ismail, Assistant Professor of the Department of Psychiatry at the University of Toronto in Canada led a study that explored what factors increased length of stay (LOS) for geriatric clients compared with adult psychiatric clients.

In a recent study, Ismail assessed 570 adult patients with mood problems and 199 geriatric patients with similar psychological issues. Demographic and medical information were collected during the first 3 days the clients were in the hospital. Ismail found that some factors contributed to lengthier stays for both groups, including negative symptoms, needing assistance with daily living activities, and overall disability. However, the length of stay was longer for the geriatric participants when they had voluntarily admitted themselves or if they lived alone. In addition, the elderly participants who needed high levels of supervision were also admitted for longer periods of time than those who needed less observation.

Ismail believes that early identification of mood disorders, such as depression, is critical for elderly individuals. Many of the participants in this study, and many of those who receive hospitalization, may have psychological problems long before they ever enter the hospital. Experiencing the death of a loved one or a significant physical health problem could exacerbate symptoms that were otherwise minimal. Primary care physicians, family members, and friends should work together to recognize signs of mental illness in order to provide care at the community level before inpatient care is warranted. Clinicians can help clients develop tools to maintain independence and overcome the challenges of living alone in ways that can prevent further progression of symptoms. “Addressing these predictive factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources,” Ismail said.

Ismail, Zahinoor, Tamara Arenovich, Charlotte Grieve, Peggie Willett, Gautam Sajeev, David C. Mamo, Glenda M. MacQueen, and Benoit H. Mulsant. Predicting hospital length of stay for geriatric patients with mood disorders. Canadian Journal of Psychiatry 57.11 (2012): 696-703. Print.

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  • jennifer morris

    jennifer morris

    December 26th, 2012 at 2:35 AM

    Nice and very informative blog but my question is how to check if any person suffering depression before going to a therapist.

  • merle


    December 26th, 2012 at 6:43 AM

    One thing that I have always noticed is that no one in geriatric care wants to believe that there are serious mental health issues in their patients that need to be treated. They just always assume that they are simply getting old and that this is the end all and be all excuse for the feelings that they are having. I think that it is too often ignored that they can be depressed and nervous and anxious too, and that this has to be treated in them in the same way that you would younger patients. Have they thought about just how much this little bit of effort could improve their quality of life for the time that they have left?

  • es


    December 26th, 2012 at 8:11 AM

    Merle, I have to agree with you. In fact, I even did it with my own grandmother. and I work in the field of psychiatry. When I was in my late 20’s, she started getting irritable and saying some irrational things. I took it to be that she was just getting older and didn’t think much about. But, when my uncle took her to the doctor, she was, in fact, suffering from depression. I certainly think this is a timely and well written article.

  • dawn


    December 26th, 2012 at 8:13 AM

    It’s just so sad that people often don’t consider than the elderly can have a mental illness such as depression and that it can go untreated. My hope is that caregivers will read this and other similar articles and being to understand the importance of mental health evaluations in the elderly.

  • Jeff


    December 26th, 2012 at 10:45 AM

    Length of stay usually increases with the increase in severity of problems.But if seniors are spending more time in health care centres compared to others,they may be slower to process and benefit from treatment.Or maybe they are not as easy to change their thinking and habits to help them.There can be more than one single factor in this!

  • Ray


    December 26th, 2012 at 11:00 AM

    My mom would have rather died than to have known that she was receiving treatment for mental illness.

    She was so proud right up until the end, and even though her doctor was treating her for a mild form of depression, we never told her that outright because she would have never admitted that she needed and help anyway.

    You have to tread so carefully with this population because so many of them have lived such long and otherwise full lives that to admit that they are having some problems coping with life day to day could be such a challenge for many of them, and one that sadly that could be so defeating.

  • kacey


    December 26th, 2012 at 6:41 PM

    elders are prone to depression more than others because they spend time alone and their social lives are not too lively.also they may reflect too much upon the negative things in life.all this may contribute to symptoms being present for longer before being detected,thereby lengthening their stay.

  • randy


    December 26th, 2012 at 11:17 PM

    are they sure it’s not because the older patients feel the need to be taken care of?because most I then are lonely and any form of care and interaction is welcome for them.maybe they prefer to stay longer for the same reason?

  • Belinda


    December 27th, 2012 at 4:13 AM

    Are most mental health familities equipped to deal with the special needs presented by geriatric patients?

  • jenna


    December 27th, 2012 at 1:33 PM

    whatever be the age,longer the los more the chances of a serious issue.if symptoms r identified and treatment sought early then los can be less but longer los for older patients is a sign that they r not seeking treatment as early as they probably should.

  • Delia S

    Delia S

    December 28th, 2012 at 3:59 AM

    Are they equipped to handle these patients? It depends on the facility. A family has to have the correct diagnosis from a physician in order to know what sort f treatment will be the most beneficial for their family member and just how to go about finding a place where not only can their mental health needs be addressed, but where they can also continue to receive the care for their physical health that likley they will continue to need. I know that there are many residential programs which focus solely on young people or even avergae age adults, but you would have to do a ,ot of research I would think to find a place that specifically addresses the mental health issues and needs of our older population.

  • paula


    December 28th, 2012 at 3:44 PM

    many abilities decline with age.the same could hold true for the ability to heal and cure.I personally do not find it surprising that older patients take longer than their younger counterparts.that is why they’re old,duh!

  • Gloria


    December 28th, 2012 at 11:11 PM

    “the length of stay was longer for the geriatric participants when they had voluntarily admitted themselves or if they lived alone.”

    Living alone can be hard for old people. Not only the physical aspect where they have to do everything by themselves but also on a mental level they feel lonely at a time when they need company the most.

    I visit care homes where such people live and the sense of community there can help.Although it cannot match living with one’s family it is at least better than living all by yourself when you are in need of assistance.

  • Paul


    December 29th, 2012 at 4:14 AM

    The very same statement that Gloria just wrote about is the same line in this piece that just jumped out at me!

    Maybe a good deal of this has to do with a degree of loneliness in the elderly that many of us who are younger do not yet understand. They are so worn down by being alone and really feeling like they have no one to turn to that they would rather stay in a facility such as this where they are receiving care and treatment than to be at home alone. I get that. But that needs to be something addressed with the family as well if there is any. An easy fix sometimes is to have more people surround the patinet. many times that’s all they want is to feel like no one has forgotten about them and that they are still relevant to someone.

  • russell


    December 29th, 2012 at 2:21 PM

    easy for them to be depressed and there y exacerbate symptoms of mental health problems if they do not remain active.its so important to have a social life and do things that make you feel good about yourself.

    People tend to ignore these things as they age.eventhose that are ‘taking care’ of their health only do so with the physical health and not too many people even pay attention to their mental health.that needs to change.the fact that mental health was not given as much importance in the past decades may also lead them to believe the same,causing them to ignore early symptoms.

  • Ross


    December 30th, 2012 at 7:49 AM

    I don’t think length of stay is really a good measure of a patient and his symptom severity.Some people may take longer to recoup than others,especially because such variances are seen in mental health treatment.The older people may take more time to get adjusted to the techniques and nuances of treatment.Not too much should be read here IMO.

  • ruth


    December 30th, 2012 at 3:47 PM

    were the participants included have the mental health issues only in their later years or were these issues present long-term?because having an issue long term changes a lot of dynamics – such as learning to live with it,prior treatment,severity etcetera.

  • Trudy


    December 31st, 2012 at 6:00 AM

    I sincerely hope that as time goes on and we continue to evolve as a society, there will be a recgnition among health care providers and professionals that for many older patients this is not just about the fact that they are getting older, but this is a serious mental health issue that needs to be addressed in this population. And I hope that in that vein, geriatric providers themselves won’t necessarily try to treat this alone but will seek the help of psychatrists and therapists for their patients who are trained to deal with the very specific issues facing the elderly and mental health.

  • e taylor

    e taylor

    December 31st, 2012 at 1:33 PM

    they may have difficulty in adopting to the therapy..maybe a therapy method that is right for them doesn’t even many times one therapy method doesn’t suit a person and they derive no benefits from it.maybe the same is happening with the older folk.

    most of the studies have young people and thus the therapy methods could be appropriate for them, thereby making it harder for the older people!

  • Jeremy


    December 31st, 2012 at 10:33 PM

    Oh age can play a role in recovery process!Just like for physical health when recovering the seniors do tend to take longer with mental health too.Its just the way it is.Road ahead would be to tweak the treatment to suit the seniors better.

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