Predicting rehospitalisation in older inpatients with a psychotic disorder.

OBJECTIVE: The objective of this study was to predict rehospitalisation in a psychiatric clinic in older inpatients with a psychotic disorder. METHODS/DESIGN: In this prospective, observational study, all eligible inpatients aged 55 years and over with a primary psychotic disorder, admitted to a specialised ward for older psychotic patients in a large psychiatric inpatient clinic in the Netherlands, were asked to participate. Whether or not patients were rehospitalised and time to rehospitalisation were assessed 1 year after discharge from the ward. We recorded age, gender, living arrangement, psychiatric diagnosis, severity of psychotic symptoms, duration of index episode, age of onset of psychotic disorder, number of previous admissions, involuntary admission and use of depot medication at discharge. All patients underwent a neuropsychological assessment. RESULTS: Of the 90 patients that were included, 32 (35.6%) had been readmitted within 1 year after discharge. None of the demographic or clinical variables predicted rehospitalisation or the time to rehospitalisation. CONCLUSION: Factors that predict rehospitalisationin younger adult patients with schizophrenia may not predict rehospitalisationin older patients with a psychotic disorder, of which the majority suffered from schizophrenia. We expect that other factors than those investigated may be of greater importance to predict rehospitalisation, as for example social support and coping mechanisms.

Gender Differences in Cognitive Functioning in Older Alcohol-Dependent Patients.

BACKGROUND: Alcohol dependence is associated with impairments in cognition, especially in later life. Previous studies suggest that excessive drinking has more negative impact on cognition in women than in men. OBJECTIVES: In this study, differences in cognition between male and female older, alcohol-dependent patients were examined. METHOD: Older alcohol-dependent inpatients (N = 164, 62.2% men, mean age 62.6 ± 6.4) underwent neuropsychological tests of sensitivity to interference, mental flexibility, and visual processing. RESULTS: No gender differences were found in age, educational level, estimated premorbid verbal intelligence, and sensitivity to interference. Duration of alcohol dependence was longer for men than for women. Men performed better than women on visual processing, and women better than men on mental flexibility. The superior mental flexibility of women remained significant after adjustment for duration of alcohol dependence. Conclusions/Importance: Older alcohol-dependent inpatients performed below average on cognitive tasks, which suggests that long-term excessive alcohol use negatively affects cognition. Our study does not demonstrate more severe cognitive impairment in women than in men.

Social factors and readmission after inpatient detoxification in older alcohol-dependent patients.

BACKGROUND AND OBJECTIVES: Alcohol dependence is often a chronic relapsing disorder with frequent admissions to inpatient facilities. This study in older alcohol-dependent inpatients investigates the role of social factors in readmissions after inpatient detoxification. METHODS: In a prospective study, 132 older alcohol-dependent patients admitted to inpatient detoxification (mean age 63.4, SD = 6.6, 39.4% women) were interviewed with the European version of the Addiction Severity Index (Europ-ASI). Readmission to inpatient treatment was monitored up to 1 year after discharge. The effect of social factors on readmission, the number of readmissions and the time to first readmission was established using group comparisons, Poisson regression analysis, and Cox' proportional hazards regression analysis, respectively. RESULTS: Sixty-seven (50.8%) of the 132 patients were readmitted within 1 year. In this group, the median number of readmissions was 2 (IQR = 2, range 1-6) and the median time to first readmission was 88 days (IQR = 116, range 3-356). In a multivariate analysis, spending most leisure time alone predicted fewer readmissions. None of the other social factors predicted readmission, number of readmissions or time to first readmission. DISCUSSION AND CONCLUSIONS: Rehospitalization of older alcohol-dependent patients after detoxification is very common, and generally not predicted by social factors. Only spending most leisure time alone may play a role. SCIENTIFIC SIGNIFICANCE: This study shows that most social factors are-unexpectedly-not associated with rehospitalization of older alcohol-dependent patients after detoxification. "Spending leisure time alone" warrants further study as a potentially modifiable predictor.

Cognitive functioning in older adults with early, late, and very late onset alcohol dependence.

BACKGROUND: Alcohol dependence in older adults is associated with cognitive impairment. Age of onset of alcohol dependence is an important criterion to distinguish subgroups of alcohol-dependent people. Little is known about the influence of the age of onset of alcohol dependence on cognitive functioning. The primary aim of this study was to examine if older alcohol-dependent people with early, late or very late onset of alcohol dependence differ in terms of cognitive dysfunction. METHODS: A total of eighty-five older alcohol-dependent people who were admitted to an inpatient detoxification program, were categorized into three age of onset groups: early onset (< 25 years: N = 27, mean age 57.7 ± 7.4), late onset (25-44 years: N = 28, mean age 61.1 ± 6.7) and very late onset (≥ 45 years: N = 30, mean age 65.6 ± 6.5). A neuropsychological test battery (Kaufman-Short Neuropsychological Assessment Procedure (K-SNAP), Trail Making Test (TMT) and Stroop Color Word Test) was administered to assess cognitive functioning. Differences between groups were examined with analyses of variance (ANOVAs). RESULTS: There were no significant differences in performance on any of the neuropsychological measures between the three age of onset groups. However, compared to a non-alcohol-dependent norm group, all three age of onset groups performed below average. CONCLUSIONS: The results suggest that older adults who start drinking heavily (very) late in life have similar cognitive impairments compared to their peers who have been drinking for decades. This emphasizes the vulnerability of the aging brain to the toxic effects of alcohol.

Physical and mental health and social functioning in older alcohol-dependent inpatients: the role of age of onset.

AIMS: Age of onset is an important criterion to distinguish subgroups of alcohol-dependent patients. This study investigated physical and mental health and social functioning of older inpatients with early (age <25), late (25-44), and very late (≥45) onset of alcohol dependence. METHODS: In a specialized detoxification ward for older patients in The Hague, the Netherlands, 157 older alcohol-dependent inpatients (38% women, mean age 62.7 ± 6.5) were interviewed with the European version of the Addiction Severity Index. RESULTS: As a group, older alcohol-dependent patients had substantial physical, mental and social problems, which were largely independent of the age of onset of alcohol dependence. Patients with early-onset alcohol dependence had more chronic medical problems and more suicidal thoughts than patients with late-onset alcohol dependence. The very-late-onset group did not significantly differ from the other two groups in any of the variables under study. CONCLUSIONS: Despite previous studies showing more favourable outcomes for the (very) late-onset compared to the early-onset alcohol-dependent group, their comorbid (mental) health and social problems are in many respects similar, and require careful assessment and treatment. This may be crucial for successful treatment and improving quality of life in these patients.