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

Copeland LA, Ettinger AB, Zeber JE, Gonzalez JM, Pugh MJ - BMC Health Serv Res (2011)

Bottom Line: 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).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).From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Veterans Affairs: Central Texas Veterans Health Care System, 2102 Birdcreek Drive, Temple, TX 76502, USA. LaurelACopeland@gmail.com

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.

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Selected Factors Contrasting Odds Ratios Associated with Medical Admission and Those Associated with Psychiatric Admission among Geriatric Patients with New-Onset Epilepsy (OR = 1 is n.s.)
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Figure 1: Selected Factors Contrasting Odds Ratios Associated with Medical Admission and Those Associated with Psychiatric Admission among Geriatric Patients with New-Onset Epilepsy (OR = 1 is n.s.)

Mentions: To our knowledge, this is the first paper to examine the high rates of hospital admissions among elderly new-onset epilepsy patients (52%), relative to elderly patients without epilepsy (15%). Results suggest that the diagnosis of epilepsy in this population signifies a risk not only for recurrent seizures but also for hospitalization for a diversity of medical and psychiatric conditions. In this large sample of older patients using the VA healthcare system, those with new-onset epilepsy had more admissions compared to similar patients without epilepsy. Our study also highlights the association of multiple comorbidities and race/ethnicity with hospitalization among older veterans, and, strikingly, of alcohol dependence (see Figure 1). Alcohol dependence in the elderly is under-diagnosed yet a major factor in hospitalizations in this age group [18].


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

Copeland LA, Ettinger AB, Zeber JE, Gonzalez JM, Pugh MJ - BMC Health Serv Res (2011)

Selected Factors Contrasting Odds Ratios Associated with Medical Admission and Those Associated with Psychiatric Admission among Geriatric Patients with New-Onset Epilepsy (OR = 1 is n.s.)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108373&req=5

Figure 1: Selected Factors Contrasting Odds Ratios Associated with Medical Admission and Those Associated with Psychiatric Admission among Geriatric Patients with New-Onset Epilepsy (OR = 1 is n.s.)
Mentions: To our knowledge, this is the first paper to examine the high rates of hospital admissions among elderly new-onset epilepsy patients (52%), relative to elderly patients without epilepsy (15%). Results suggest that the diagnosis of epilepsy in this population signifies a risk not only for recurrent seizures but also for hospitalization for a diversity of medical and psychiatric conditions. In this large sample of older patients using the VA healthcare system, those with new-onset epilepsy had more admissions compared to similar patients without epilepsy. Our study also highlights the association of multiple comorbidities and race/ethnicity with hospitalization among older veterans, and, strikingly, of alcohol dependence (see Figure 1). Alcohol dependence in the elderly is under-diagnosed yet a major factor in hospitalizations in this age group [18].

Bottom Line: 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).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).From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Veterans Affairs: Central Texas Veterans Health Care System, 2102 Birdcreek Drive, Temple, TX 76502, USA. LaurelACopeland@gmail.com

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.

Show MeSH
Related in: MedlinePlus