An examination of premature mortality among decedents with serious mental illness and those in the general population.
*Mortality; *Severity of Illness Index; 80 and over; 80 and Over; Aged; Cause of Death – Trends; Cause of Death/trends; Death Certificates; Female; Human; Humans; Male; Mental Disorders – Mortality; Mental Disorders/*mortality; Middle Age; Middle Aged; Mortality; Ohio; Ohio/epidemiology; Population Surveillance; Retrospective Design; Retrospective Studies; Severity of Illness Indices
OBJECTIVES: The primary aim of this retrospective study of death records was to determine whether there were significant differences in years of potential life lost (YPLL) between decedents with serious and persistent mental illness at a community mental health center (N=647) and decedents in the general population (N=15,517) after the analysis adjusted for sociodemographic factors and cause of death. METHODS: Clinical case management files from a community mental health center were matched to state death records from 1998 to 2004 to identify decedents being treated for a serious and persistent mental illness. Differences in leading causes of death and YPLL were calculated with descriptive and multivariate methods. RESULTS: Mean+/-SD YPLL for the decedents with serious and persistent mental illness was 14.5+/-10.6, compared with 10.3+/-6.7 for the general population. Heart disease was the leading cause of death for both groups. Mean differences in YPLL after adjustment for gender, race, marital status, and education ranged from 1.7 years for chronic lower respiratory disease to 13.1 years for accidents and were significant for every leading cause of death. Differences in cause of death did not explain the difference in YPLL. Suicide, cancer, accidents, liver disease, and septicemia were differentially associated with YPLL for persons with serious and persistent mental illness. CONCLUSIONS: Suicide, cancer, accidents, liver disease, and septicemia increased premature mortality among persons with serious and persistent mental illness. Along with ongoing suicide prevention programs, efforts to integrate primary and psychiatric care should focus on these preventable causes of early death.
Piatt Elizabeth E; Munetz Mark R; Ritter Christian
Psychiatric services (Washington, D.C.)
2010
2010-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1176/ps.2010.61.7.663" target="_blank" rel="noreferrer noopener">10.1176/ps.2010.61.7.663</a>
Professional judgments about advance care planning with community-dwelling consumers.
*Attitude of Health Personnel; *Decision Making; *Health Care Surveys; Advance Care Planning; Advance Care Planning/organization & administration/*statistics & numerical data; Attitude of Health Personnel; Consumer Behavior/*statistics & numerical data; Consumer Satisfaction – Statistics and Numerical Data; Decision Making; Human; Humans; Management; Midwestern United States; Models; Organizational; Patient Satisfaction – Statistics and Numerical Data; Patient Satisfaction/*statistics & numerical data; Population Surveillance; Questionnaires; Randomized Controlled Trials; Surveys; Surveys and Questionnaires
CONTEXT: There is limited research on how community-based long-term care (CBLTC) providers' personal characteristics and attitudes affect their decisions to initiate advance care planning (ACP) conversations with consumers. OBJECTIVES: To examine judgments by CBLTC providers as to whether a consumer was in need of ACP and to compare the relative influence of situational features of the consumer with the influence of personal characteristics of the CBLTC provider. METHODS: Factorial surveys with vignettes with randomly assigned situational features of a hypothetical consumer were obtained from 182 CBLTC providers at three Area Agencies on Aging located in the Midwestern U.S. Measures included the consumer's situational features, such as demographics, diagnosis, pain level, level of functioning, and caregiver involvement. Personal characteristics of the CBLTC provider included demographics, discipline, past experience with ACP, and attitudes toward ACP. RESULTS: Hierarchical linear models indicated that most variability in ACP decisions was the result of differences among CBLTC providers (64%) rather than consumers' situational features. Positive decisions to discuss ACP were associated with consumers who needed assistance with legal issues and had a cancer diagnosis; these variables explained 8% of the vignette level variance. Significant personal characteristics of the CBLTC provider included a nursing background, less direct contact with consumers, past experience with ACP, and positive attitudes toward ACP; these variables explained 41% of the person-level variance. CONCLUSION: This study shows the lack of normative consensus about ACP and highlights the need for consistent educational programs regarding the role of the CBLTC provider in the ACP process.
Baughman Kristin R; Ludwick Ruth E; Merolla David M; Palmisano Barbara; Hazelett Susan; Winchell Janice; Hewit Michael
Journal of pain and symptom management
2012
2012-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpainsymman.2011.03.023" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2011.03.023</a>