Characteristics Associated with Inpatient Versus Outpatient Status in Older Adults with Bipolar Disorder

Abstract

Objectives This is an exploratory analysis of ambulatory and inpatient services utilization by older persons with type I bipolar disorder experiencing elevated mood. The association between type of treatment setting and the person’s characteristics is explored within a framework that focuses upon predisposing, enhancing, and need characteristics. Method Baseline assessments were conducted with the first 51 inpatients and 49 outpatients 60 years of age and older, meeting criteria for type I bipolar disorder, manic, hypomanic, or mixed episode enrolled in the geriatric bipolar disorder study (GERI-BD) study. We compared participants recruited from inpatient versus outpatient settings in regard to the patients’ predisposing, enabling, and need characteristics. Results Being treated in an inpatient rather than an outpatient setting was associated with the predisposing characteristic of being non-Hispanic caucasian (odds ratio [OR]: 0.1; P = .005) and past history of treatment with first-generation antipsychotics (OR: 6.5; P < .001), and the need characteristic reflected in having psychotic symptoms present in the current episode (OR: 126.08; P < .001). Conclusion Ethnicity, past pharmacologic treatment, and current symptom severity are closely associated with treatment in inpatient settings. Clinicians and researchers should investigate whether closer monitoring of persons with well-validated predisposing and need characteristics can lead to their being treated in less costly but equally effective ambulatory rather than inpatient settings.

Measurement tools for assessment of older age bipolar disorder: A systematic review of the recent global literature

“…We found 53 articles on OABD in the last 6 years . Of those, 50 (94%) papers examined clinical samples ranging from 10 to 315 subjects (total of 3302 subjects, mean ± standard deviation (SD) 62.3 ± 51.5 subjects/paper, median 53 subjects/paper).…”

Assessing bipolar disorder in the older adult: the GERI‐BD toolbox

“…There has been conflicting clinical impression and limited evidence regarding potential differences in severity levels and symptom profile in older mania BD patients compared with younger patients (Slater and Roth, ; Broadhead and Jacoby, ; Young et al ., ; Oostervink et al ., ; Al Jurdi et al ., ).…”

“…Pharmacotherapy guidelines for younger patients with BD cannot be extrapolated directly to older adults (Snowdon, ; Young et al ., ). Although acute BD affective states may present with similar profiles and severity in older and young patient (Al Jurdi, et al ., ), guideline recommendations for the treatment of older adults with BD need to be further developed to meet the growing need of older adults and clinical heterogeneity in BD across the life span (Dols et al ., ).…”

Correlates of psychiatric hospitalization in a clinical sample of Canadian adolescents with bipolar disorder

“…Psychosis was significantly associated with psychiatric hospitalization. Psychosis has been previously shown to predict psychiatric hospitalization in adults [18], and patients with psychotic BD have been found to experience a first hospitalization at a younger age than individuals with BD and no psychosis [56]. Psychosis can accompany mania, which was responsible for half of the psychiatric hospitalizations in this sample.…”

“…Hospitalizations among adults with BD have been associated with substance use disorders (SUD) [12][13][14][15], rapid cycling [16,17], psychosis [18], previous hospitalization [19,20], BD-I subtype [21], female gender [22,23], various medications [11,[16][17][18][24][25][26][27][28], minority status [18], polypharmacy [27], and marital separation [13].…”