75. LOSS OF INDEPENDENT LIVING: THE PROBLEM AND THE SOLUTION

Introduction

It is estimated that the number of older adults with mental illness will rise from 4 million in 1970 to 15 million by 2030. Loss of independent living among the elderly is frequently precipitated by psychiatric disorders that impair cognitive and functional capacities. Research shows that individuals who are given the opportunity to age in place generally live longer and report greater happiness than those forced into nursing homes. As the population ages, understanding the interplay between psychiatric disorders and independent living becomes increasingly vital. This study aims to assess living status at admission and discharge for geriatric psychiatric patients, focusing on how different diagnoses lead to differing rates of functional disability and independent living status. By identifying the disorders most likely to precipitate entry into nursing homes, we can enhance the provision of services in residential care, thereby supporting aging in place and improving longevity. Early identification and management of these conditions are critical for improving outcomes and maintaining autonomy in geriatric patients. This literature review examines how these psychiatric disorders impact the ability of geriatric patients to live independently and strategies that can be employed to mitigate these effects.

Methods

A literature review was conducted using databases such as PubMed and PsycINFO, focusing on studies from the past decade that focused on psychiatric disorders contributing to the loss of independent living status in elderly populations. Sources include longitudinal cohort studies, pilot trials, and research on the outcomes of psychiatric care in residential settings and home treatment. Studies were analyzed for patterns linking these conditions to loss of independent living.

Results

Results from the literature search yielded several studies with the following important conclusions. One study found that hospital inpatients with psychiatric disorders were 77% more likely to be discharged to a nursing home compared to those without psychiatric disorders. Another study focusing on elderly patients with depression found that depression-related cognitive decline was often associated with substantial impairment in instrumental activities of daily living (IADL). These studies emphasize the profound impact of psychiatric illness on the loss of functional ability in geriatric patients. A longitudinal cohort study on patients with recent-onset major psychiatric illness found that patients with bipolar disorder had better outcomes and were at lower risk of losing independent living status compared to those with depression and schizophrenia, indicating that functional impairment varies depending on the type of psychiatric illness. In a pilot study of 12 elderly patients with depression or delusions, a specialized psychosocial intervention program called Geriatric Psychiatry Home Treatment (GHT) was implemented. After one year, while psychiatric symptoms remained largely unchanged, patients experienced significant improvements in mental quality of life, demonstrating the promise of customized treatment programs for the preservation of functional health for geriatric patients with mental illness.

Conclusions

Major psychiatric disorders, including bipolar disorder, major depression, and schizophrenia, significantly contribute to the decline in independent living among older adults. This loss of independence often accelerates the deterioration of both mental and physical health. This research indicates that some psychiatric conditions have a greater impact on independence than others, emphasizing the importance of early detection and treatment. Furthermore, specialized psychosocial programs have been shown to preserve functional health better than standard treatment modalities. Future studies should focus on enhancing psychiatric care in assisted living environments, developing home-based treatment models, and improving preventive strategies via tailored treatment programs to reduce the risk of early institutionalization and promote better health outcomes.