Psychiatric comorbidity and the long-term care of people with AIDS

Objectives. To examine the association of comorbid psychiatric disorders wi th admission and discharge characteristics for patients residing at a long- term care facility designated for acquired immunodeficiency syndrome (AIDS) . Methods. Demographic and clinical characteristics were obtained by systemat ic chart review for all patients (N = 180) admitted to the facility from it s opening in October 1995 through December 1999. Lifetime history of severe and persistent psychiatric disorders (major depression, bipolar and psycho tic disorders) was determined by current diagnosis on baseline clinical eva luation or a documented past history. Results. Forty-five patients (25%) had comorbid psychiatric disorders. At a dmission, patients with comorbidity were more likely to be ambulatory (80% vs. 62%, P = .03) and had fewer deficits in activities of daily living (27% vs. 43%, P = .05). After controlling for human immunodeficiency virus (HIV ) disease severity, patients with comorbidity had significantly lower disch arge rates (relative risk = 0.43, 95% confidence interval 0.23-0.78, P = .0 001) and death rates (relative risk = 0.53, 95% confidence interval 0.42-0. 68, P = .009). Conclusions. Patients with AIDS and comorbid psychiatric disorders at this facility had more favorable admission characteristics and were less likely to be discharged or to die. They may have been admitted earlier in their di sease course for reasons not exclusively due to HIV infection. Once admitte d, community-based residential alternatives may be unavailable as a dischar ge option. These findings are unlikely to be an anomaly and may become more pronounced with prolonged survival due to further therapeutic improvements in HIV care. Health services planners must anticipate rising demands on th e costs of care for an increasing number of patients who may require long-t erm care and expanded discharge options for the comanagement of HIV disease and chronic psychiatric disorders.