Psychiatric and medical admissions observed among elderly patients with new-onset epilepsy

Laurel A. Copeland, Alan B. Ettinger, John E. Zeber, Jodi M. Gonzalez, Mary Jo Pugh

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Inpatient utilization associated with incidence of geriatric new-onset epilepsy has not been characterized in any large study, despite recognized high levels of risk factors (comorbidity). Methods. Retrospective study using administrative data (Oct '01-Sep '05) from the Veterans Health Administration from a nationwide sample of 824,483 patients over age 66 in the retrospective observational Treatment In Geriatric Epilepsy Research (TIGER) study. Psychiatric and medical hospital admissions were analyzed as a function of patient demographics, comorbid psychiatric, neurological, and other medical conditions, and new-onset epilepsy. Results: Elderly patients experienced a 15% hospitalization rate in FY00 overall, but the subset of new-onset epilepsy patients (n = 1,610) had a 52% hospitalization rate. New-onset epilepsy was associated with three-fold increased relative odds of psychiatric admission and nearly five-fold increased relative odds of medical admission. Among new-onset epilepsy patients, alcohol dependence was most strongly associated with psychiatric admission during the first year after epilepsy onset (odds ratio = 5.2; 95% confidence interval 2.6-10.0), while for medical admissions the strongest factor was myocardial infarction (odds ratio = 4.7; 95% confidence interval 2.7-8.3). Conclusion: From the patient point of view, new-onset epilepsy was associated with an increased risk of medical admission as well as of psychiatric admission. From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions. Finally, from a health systems perspective, the emerging picture of the epilepsy patient with considerable comorbidity and demand for healthcare resources may merit development of practice guidelines to improve coordinated delivery of care.

Original languageEnglish (US)
Article number84
JournalBMC Health Services Research
Volume11
DOIs
StatePublished - 2011

Fingerprint

Psychiatry
Epilepsy
Odds Ratio
Geriatrics
Comorbidity
Hospitalization
Confidence Intervals
Veterans Health
United States Department of Veterans Affairs
Psychiatric Hospitals
Practice Guidelines
Alcoholism
Inpatients
Retrospective Studies
Myocardial Infarction
Demography
Delivery of Health Care
Incidence
Health
Research

ASJC Scopus subject areas

  • Health Policy

Cite this

Psychiatric and medical admissions observed among elderly patients with new-onset epilepsy. / Copeland, Laurel A.; Ettinger, Alan B.; Zeber, John E.; Gonzalez, Jodi M.; Pugh, Mary Jo.

In: BMC Health Services Research, Vol. 11, 84, 2011.

Research output: Contribution to journalArticle

Copeland, Laurel A. ; Ettinger, Alan B. ; Zeber, John E. ; Gonzalez, Jodi M. ; Pugh, Mary Jo. / Psychiatric and medical admissions observed among elderly patients with new-onset epilepsy. In: BMC Health Services Research. 2011 ; Vol. 11.
@article{68d3177e333b4c06b5c5e0de18dbfb5b,
title = "Psychiatric and medical admissions observed among elderly patients with new-onset epilepsy",
abstract = "Background: Inpatient utilization associated with incidence of geriatric new-onset epilepsy has not been characterized in any large study, despite recognized high levels of risk factors (comorbidity). Methods. Retrospective study using administrative data (Oct '01-Sep '05) from the Veterans Health Administration from a nationwide sample of 824,483 patients over age 66 in the retrospective observational Treatment In Geriatric Epilepsy Research (TIGER) study. Psychiatric and medical hospital admissions were analyzed as a function of patient demographics, comorbid psychiatric, neurological, and other medical conditions, and new-onset epilepsy. Results: Elderly patients experienced a 15{\%} hospitalization rate in FY00 overall, but the subset of new-onset epilepsy patients (n = 1,610) had a 52{\%} hospitalization rate. New-onset epilepsy was associated with three-fold increased relative odds of psychiatric admission and nearly five-fold increased relative odds of medical admission. Among new-onset epilepsy patients, alcohol dependence was most strongly associated with psychiatric admission during the first year after epilepsy onset (odds ratio = 5.2; 95{\%} confidence interval 2.6-10.0), while for medical admissions the strongest factor was myocardial infarction (odds ratio = 4.7; 95{\%} confidence interval 2.7-8.3). Conclusion: From the patient point of view, new-onset epilepsy was associated with an increased risk of medical admission as well as of psychiatric admission. From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions. Finally, from a health systems perspective, the emerging picture of the epilepsy patient with considerable comorbidity and demand for healthcare resources may merit development of practice guidelines to improve coordinated delivery of care.",
author = "Copeland, {Laurel A.} and Ettinger, {Alan B.} and Zeber, {John E.} and Gonzalez, {Jodi M.} and Pugh, {Mary Jo}",
year = "2011",
doi = "10.1186/1472-6963-11-84",
language = "English (US)",
volume = "11",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Psychiatric and medical admissions observed among elderly patients with new-onset epilepsy

AU - Copeland, Laurel A.

AU - Ettinger, Alan B.

AU - Zeber, John E.

AU - Gonzalez, Jodi M.

AU - Pugh, Mary Jo

PY - 2011

Y1 - 2011

N2 - Background: Inpatient utilization associated with incidence of geriatric new-onset epilepsy has not been characterized in any large study, despite recognized high levels of risk factors (comorbidity). Methods. Retrospective study using administrative data (Oct '01-Sep '05) from the Veterans Health Administration from a nationwide sample of 824,483 patients over age 66 in the retrospective observational Treatment In Geriatric Epilepsy Research (TIGER) study. Psychiatric and medical hospital admissions were analyzed as a function of patient demographics, comorbid psychiatric, neurological, and other medical conditions, and new-onset epilepsy. Results: Elderly patients experienced a 15% hospitalization rate in FY00 overall, but the subset of new-onset epilepsy patients (n = 1,610) had a 52% hospitalization rate. New-onset epilepsy was associated with three-fold increased relative odds of psychiatric admission and nearly five-fold increased relative odds of medical admission. Among new-onset epilepsy patients, alcohol dependence was most strongly associated with psychiatric admission during the first year after epilepsy onset (odds ratio = 5.2; 95% confidence interval 2.6-10.0), while for medical admissions the strongest factor was myocardial infarction (odds ratio = 4.7; 95% confidence interval 2.7-8.3). Conclusion: From the patient point of view, new-onset epilepsy was associated with an increased risk of medical admission as well as of psychiatric admission. From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions. Finally, from a health systems perspective, the emerging picture of the epilepsy patient with considerable comorbidity and demand for healthcare resources may merit development of practice guidelines to improve coordinated delivery of care.

AB - Background: Inpatient utilization associated with incidence of geriatric new-onset epilepsy has not been characterized in any large study, despite recognized high levels of risk factors (comorbidity). Methods. Retrospective study using administrative data (Oct '01-Sep '05) from the Veterans Health Administration from a nationwide sample of 824,483 patients over age 66 in the retrospective observational Treatment In Geriatric Epilepsy Research (TIGER) study. Psychiatric and medical hospital admissions were analyzed as a function of patient demographics, comorbid psychiatric, neurological, and other medical conditions, and new-onset epilepsy. Results: Elderly patients experienced a 15% hospitalization rate in FY00 overall, but the subset of new-onset epilepsy patients (n = 1,610) had a 52% hospitalization rate. New-onset epilepsy was associated with three-fold increased relative odds of psychiatric admission and nearly five-fold increased relative odds of medical admission. Among new-onset epilepsy patients, alcohol dependence was most strongly associated with psychiatric admission during the first year after epilepsy onset (odds ratio = 5.2; 95% confidence interval 2.6-10.0), while for medical admissions the strongest factor was myocardial infarction (odds ratio = 4.7; 95% confidence interval 2.7-8.3). Conclusion: From the patient point of view, new-onset epilepsy was associated with an increased risk of medical admission as well as of psychiatric admission. From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions. Finally, from a health systems perspective, the emerging picture of the epilepsy patient with considerable comorbidity and demand for healthcare resources may merit development of practice guidelines to improve coordinated delivery of care.

UR - http://www.scopus.com/inward/record.url?scp=79955112011&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955112011&partnerID=8YFLogxK

U2 - 10.1186/1472-6963-11-84

DO - 10.1186/1472-6963-11-84

M3 - Article

VL - 11

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

M1 - 84

ER -