Who Cares Wins - Royal College of Psychiatrists

14
Figure 1.2
The effect of mental disorder on survival after hip fracture (107)
Proportion surviving
1.0
.9
.8
.7
.6
.5
.4
.3
.2
.1
0.0
0 250 500 750
1.14 Why are outcomes so poor in this group? There are several possible explanations. One is that
the presence of a mental disorder, like delirium, simply represent serious underlying physical
pathology which is the real cause of the poor outcome. When studies control for this factor and
other variables that might determine outcome, such as increased age and severity of physical
illness, the majority find that mental disorder is an independent predictor of poor outcome That is,
the presence of the mental disorder itself has an adverse effect.
• The presence of a mental disorder is an independent predictor of
poor outcome.
1.15 The cost of these disorders to older people and their carers is substantial and the cost to services
considerable. For example, in 2001, in the United States, delirium was estimated to complicate the
hospital admission of more than 2.3 million older people each year involving over 17.5 million
hospital days and accounting for more than $4 billion of Medicare expenditure. (110).
Conclusion
Diagnosis
- Depression (n=93)
- Delirium (n=108)
- Dementia (n=294)
- Well (n=208)
Time (days)
1.16 Mental disorder is frequently present in older people admitted to a general hospital and will have
serious consequences for the prognosis of that older person. Furthermore, mental disorder will
have an adverse effect on the performance of the general hospital responsible for that older
persons care.