Prognosis of Mental Illness in Old Age: A Four Year Follow-up Study

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Abstract
Summary: This paper describes a four year follow-up study of psychogeriatric patients in Toronto, arising from collaboration with the U.S.-U.K. cross-national study of psychogeriatric disorders. The findings of the study are threefold: First, compared to Roth's study two decades ago, the present sample shows a decline in mortality of patients suffering from senile dementia with a corresponding increase in the need for treatment facilities for this group. Paraphrenic patients on the other hand were discharged earlier and in greater numbers, indicating an improvement in the treatment of this condition. There was no change in the discharge rate of patients with mood disorders despite the much touted use of antidepressant medications. The second finding was that patients with functional disorders were more rapidly discharged in Canada and the U.S. compared to the U.K., possibly indicating a greater pressure to discharge patients early in North America compared to Britain. Finally, the diagnostic categories had a very significant validity in predicting outcome, with organically demented patients being dead or in hospital at follow-up. The best prognosis was displayed by patients with affective disorders, two-thirds of whom were discharged to the community by 90 days. An intermediate prognosis was demonstrated by patients suffering from schizophrenia and miscellaneous functional disorders, nearly half of whom were discharged to the community in 90 days. The implications for management are discussed.