Effectiveness of a psychosomatic day hospital treatment for the elderly: A naturalistic longitudinal study with waiting time before treatment as control condition
Introduction
In geronto-psychiatric research only a small number of studies concentrate on the effectiveness of day hospital treatment [1], [2], [3]. These studies suggest day hospital treatment to be a valuable and cost effective alternative to inpatient care of patients with mental illness. Some studies of depressed elderly patients receiving day hospital treatment show a significant reduction of depressive symptoms, increased cognitive performance, and positive effects on social life, physical performance, and quality of life [4], [5], [6], [7], [8], [9]. Clinical experience suggests some additional advantages of day hospital treatment compared to inpatient treatment: Patients are not torn away from their home and social ties, therefore resistance against psychotherapeutic treatment might be smaller. However, evidence from empirical studies is missing.
Psychosomatic medicine as an own specialty besides general psychiatry is a particularity of the German health care system. Besides medical treatment and social counseling, psychosomatic inpatient and day hospital treatment focus strongly on psychotherapeutic treatment methods. As a consequence, patients with severe cognitive disturbances are not treated in psychosomatic day hospitals. Compared to psychiatric day clinics less patients with dementia, psychotic illness, and addiction disorders receive treatment. Psychosomatic day hospitals focus mainly on affective disorders, anxiety disorders, somatoform and stress-related disorders [9], [10]. Compared with research on psychiatric day hospital treatment, there is very little research focusing on psychosomatic day hospital treatment. The rare studies on psychosomatic day hospitals are either uncontrolled longitudinal trials or focus on the differences between inpatient and outpatient psychosomatic treatment [9], [10], [11], [12]. Only one study focusing on women suffering from bulimia used a randomized-controlled design [13].
So far, no studies are published on psychosomatic day hospital treatment for elderly patients despite their specific treatment needs. Elderly patients have to cope with the effect of aging and are affected by a wide range of losses: the loss of a beloved person, the loss of work or hobbies they cannot carry on, or the loss of bodily integrity. Chronic illness and frailty may be experienced as a narcissistic trauma resulting in low self-esteem and in feelings of despair [14]. Psychotherapeutic interventions can help to cope with negative affects and should facilitate a mourning process, which may improve adaptation to a life with a physical handicap [15]. To better adjust to these difficulties and to better cope with such loss is a central focus of psychosomatic treatment for the elderly [16]. Group treatment as performed in day hospital treatment provides an excellent opportunity for mutual support of patients [17].
This study aims to evaluate the effects of a psychosomatic treatment for the elderly in a day hospital setting. Compared with a waiting time without specific treatment, we expect treatment in the day hospital to significantly improve the psychological condition (anxiety and depression), physical discomfort, and interpersonal behavior of the patients. Concurrently, we expect medical service usage to decrease.
Section snippets
Design of the study
This is a naturalistic study using waiting time before admission as a control condition. Between September 2008 and April 2010, all consecutive patients referred for day hospital for elderly patients to the Psychosomatic department of the Nuremberg General Hospital (NGH) were approached. The patients were included in the study if an indication for psychosomatic day hospital treatment was made in a pre-treatment assessment by a psychosomatic specialist. The patients were primarily referred by
Study sample
124 patients fulfilled the inclusion criteria (i.e. met indication for treatment in our day hospital), the admission of 8 patients was canceled, therefore 116 patients started therapy. Exclusion criteria and reasons for canceled admission are presented in a CONSORT flow chart (Fig. 1). Nine patients dropped out early from treatment (drop-out rate = 8%). At follow-up, completed questionnaire results were available for 95 out of 107 patients, all of whom were discharged on schedule (return rate =
Discussion
This study is a naturalistic study with a 5-week waiting time before the 5-week intervention as control condition. A randomized controlled trial (RCT) was difficult due to the organization of inpatient and day hospital psychosomatic treatment in Germany. Before treatment can begin, outpatient, day hospital, or inpatient treatment must be indicated and then approved by the health insurance provider. Thus, comparison with an untreated control group or with an attention control group was not
Conclusion
The present study shows that older patients can profit from psychosomatic treatment in a day hospital setting. The results support the recommendation of expanding this specific treatment option. Compared to inpatient treatment, day hospital setting holds a number of advantages for the psychosomatic treatment of elderly patients such as a lower barrier to treatment, possibility of remaining in a familiar environment and maintaining social contacts, less potential for regression, and direct
Conflict of interest statement
No author has to declare any conflict of interest regarding the submitted manuscript and the reported study.
Acknowledgments
We gratefully thank Prof. Cornel Sieber, chair of the Department of Geriatrics at Erlangen University and – at the time of the study – chair of the Department of Internal Medicine II at NGH for his support in establishing the psychosomatic day hospital for the elderly at the NGH and his remarks on a previous draft of this manuscript, and Amanda Sandell and Lisa Albrecht for the stylistic improvements.
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