Objectives: This prospective, observation study (from June 2001 to October 2002) estimated the prevalence and co-occurrence of psychiatric function disorders (PFDs) in psychogeriatric patients suffering from cognitive function disorders at referral to clinical as well as non-clinical (transmural) psychogeriatric programmes. It is expected that PFDs, both total and individual, are positively related to the cognitive function disorders as well as the activities of daily living (ADL) handicaps. This expectation will be adjusted for general details particularly gender, age, marital status, domicile and type of primary caregiver. Exploratively, the structure of the interrelationship of PFDs, cognitive function disorders and ADL handicaps will be analysed. In addition, the general details and the structure to be identified will be described. Methods: We studied patients aged ≧ 65 years (n = 487), who were suspected to suffer from cognitive function disorders (MMSE ≤ 29) and were referred to trans-/intramural nursing home care in the Nieuwe Waterweg Noord region. General details, i.e. gender, age, marital status, domicile, primary caregiver, as well as PFDs (the Neuropsychiatric Inventory, NPI), cognition (MMSE) and ADL (Barthel Index, BI) were assessed. Results: Mean score NPI was 3.6 (SD = 2.3). Of the patients, 91.7% scored one or more NPI symptom; 81.6% two or more. Depression (43.9%), apathy (43.1%), anxiety (41.6%) and agitation/agression (31.2%) had a high prevalence. With respect to the NPI symptoms, i.e. delusion, hallucination, anxiety (more in women), agitation/aggression and irritability (more in men), there were significant gender differences on the same MMSE level. Compared with women, men were significantly younger, ADL independent, lived together with their spouse, who was often the primary caregiver. The performance of the logistic regression models for total NPI score with MMSE, BI separately as well as combined with general details was minor. The results of the regression analyses for the individual NPI symptoms showed comparable low R² values; they explained a small proportion of the variance. However, in the PRINCALS analysis the MMSE and BI highly correlated with the cognitive dimension, and the NPI with the psychiatric dimension. The model fit was good; 82.6% of the variance was explained. Conclusion: At the moment of referral to nursing home care, the prevalence and co-occurence of PFDs was high. The four main NPI symptoms were depression, apathy, anxiety and agitation/aggression. On the same level of MMSE score, gender difference was important for 3 NPI symptoms: delusion, hallucination and anxiety. NPI scores (total and per symptom) were relatively independent from MMSE, BI and general details. The PFDs – measured by the NPI – were a dimension on their own. Therefore, in psychogeriatrics it is of clinical relevance to think and act in terms of dimensions. Irrespective of a more rational psychopharmaceutical regime, this opens the door to the regular psychiatric domain for (psycho)the...

Objectives: To estimate life expectancy of psychogeriatric patients having participated in a reactivation program. To identify prognostic characteristics – on admission – for survival after discharge. Design: A prospective, clinical-empirical observational study. Setting: A Dutch psychiatric-skilled nursing home. Participants: Psychogeriatric patients (n = 75) suffering from very mild to moderate cognitive function disorders in conjunction with psychiatric function disorders. Intervention: Interdisciplinary reactivation program. Measurements: General, functional and diagnostic patient characteristics assessed on admission for the psychogeriatric reactivation program, and survival rate after discharge over a period of 7 years. Results: The probability of survival for patients who were discharged from the psychogeriatric reactivation program to their own homes or to a residential home with restricted support (‘independent’ group, n = 53) was higher (1/HR = 3.2) than for patients who were discharged to a nursing home (‘dependent’ group, n = 22). The median survival period of the reference group (community-dwelling elderly people) was 95 months (95% confidence interval, CI: 74–116), that of the ‘independent’ group 35 months (95% CI: 25–45) and that of the ‘dependent’ group 13 months (95% CI: 3–22). For the reactivated patients (n = 75), gender was the only general characteristic of prognostic value for survival after discharge (the survival rate for women was higher; hazard ratio (HR) = 3.07; 95% CI: 1.61–5.85). Age was statistically insignificant. One functional characteristic, the Global Deterioration Scale, was of prognostic significance (HR = 1.58; 95% CI: 1.11–2.23). The diagnostic characteristics of prognostic significance were: psychiatric function disorders (paranoia; HR = 2.19; 95% CI: 1.11–4.28), somatic comorbidity (urogenital pathology; HR = 1.83; 95% CI: 1.13–2.94; cardiopulmonary pathology; HR = 1.56; 95% CI: 1.16–2.07) and adequacy of the caregiver system (HR = 0.59; 95% CI: 0.33–1.03). The specific diagnostic classifications of cognitive function disorders (DSM-IV) were not of prognostic significance. It was possible to account for 32% of the variance in survival after discharge. Conclusion: The survival rate of the ‘independent’ group of patients was obviously higher (1/HR = 3.2) than that of the ‘dependent’ group. There was no overlap in the 95% CI of the median survival period after discharge. The results suggest that with respect to survival the two groups of psychogeriatric patients who participated in the intensive reactivation program differed definitely. Additionally, patients belonging to the ‘independent’ group had a greater chance to benefit from a reactivation program. The program should pay special attention to the patient characteristics on admission, which demonstrated a significant negative correlation to survival. These patient characteristics belonged to five domains (i.e. gender, cognitive function disorders, psychiatric function disorders, somatic comorbidity and adequacy of the ca...