Dropout rates and its correlates among the elderly patients attending a community health center

Abstract

Aim: The current study aimed to evaluate the dropout rates and the reasons for dropouts among elderly patients presenting with mental health problems to a community health centre. Methodology: This naturalistic, longitudinal, follow-up study was carried out in the Outpatient Setting of a community health centre in North India. The study included 169 patients, aged ≥ 60 years diagnosed with mental health problems. They were assessed at the baseline and then followed for a period of 1 year. Those who dropped out from the outpatient clinic were contacted over the phone to evaluate the reasons for dropout from treatment. Results: The mean age of the participants was 67.6 years and the mean number of years of education was 2.9. Most of the patients were female, married, Hindu, unemployed, from lower socioeconomic status, and non-nuclear families. The most common diagnosis was that of depression (42.6%), and this was followed by somatoform disorder (11.2%). The mean age of onset of psychiatric disorder was 62.2 years, with a mean duration of illness being 30.3 months. Nearly half (53.3%) of the patients dropped out of treatment after their first visit and 90% dropped out by 1 year. Overall the most common reason of drop out was complete relief of symptoms, and this was followed by the presence of family problems, and farming-related work. Among the very early drop out (never returned to clinic after the first visit) the most common reason for dropout was complete relief in symptoms, followed by inability to follow up due to family problems, no relief in symptoms, and farming-related work. Among those who dropped out within 6 months, the most common reason was complete relief of symptoms followed by lack of time due to personal reasons. When the reason for “late” dropout (dropout between 6 to 12 months) was evaluated, the most common reason was complete relief of symptoms followed by an inability to follow up due to problems in the family. Conclusion: A significant number of elderly patients with mental health-related problems drop out of treatment prematurely. Psychoeducation about the illness, outcome, and course of illness should be done at each step, and prevailing psychosocial issues need to be evaluated to reduce the rate of dropout among elderly patients with mental health-related problems attending the community health centre.