Mental Illness and Comorbidities, Aspects of Initial Evaluation (original) (raw)
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Dementia and Psychiatric Emergencies in the Elderly Population
Socijalna psihijatrija
S obzirom na kontinuirano povećanje broja starijih osoba u ukupnoj populaciji u Hrvatskoj, za očekivati je da će se broj starijih osoba s akutnim psihičkim smetnjama koje zahtijevaju hitno zbrinjavanje sve više povećavati. Najčešći psihički poremećaji kod starijih osoba su: depresivni poremećaji, kognitivni poremećaji, demencija, poremećaji vezani uz uzimanje alkohola, poremećaji vezani uz druga zdravstvena stanja i lijekovima izazvani poremećaji. Gerijatrijski bolesnici bi u pravilu prvo trebali biti pregledani od strane stručnjaka somatske medicine (internista, neurologa, kirurga) prije nego što se upućuju u hitnu psihijatrijsku službu, kako bi se ustanovilo da su primarne smetnje iz psihijatrijske domene. Izražena depresija, suicidalnost, agitacija, sklonosti lutanju i ostalim rizičnim ponašanjima kod kuće, izražena anksioznost i smanjena sposobnost brige o sebi, glavni su razlozi hospitalizacije kod ovih bolesnika. / Related to the fact of the continuous increase in the number of elderly people in the total population of Croatia, it can be expected that the number of elderly people with acute psychiatric disorders that require emergency care will increase. The most common psychiatric disorders found in the elderly are depressive disorders, cognitive disorders, dementia, alcoholrelated disorders, disorders related to other health conditions and drug-induced disorders. Geriatric patients should, generally speaking, first be reviewed by a psychosomatic medical specialist (internist, neurologist, surgeon) before they are sent to psychiatric emergency services in order to establish that the primary complaint is connected with the psychiatric domain. Pronounced depression, suicidality, agitation, wandering tendencies and other home-based risk behaviours, with anxiousness and reduced self-care ability, are the main reasons for hospitalization.
2013
Background: two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission. Methods: a follow-up study of 250 patients aged over 70 admitted to 1 of 12 wards (geriatric, medical or orthopaedic) of an English acute general hospital with a co-morbid mental health problem and followed up at 180 days. Results: twenty-seven per cent did not return to their original place of residence after the hospital admission. After 180 days 31% had died, 42% had been readmitted and 24% of community residents had moved to a care home. Only 31% survived without being readmitted or moving to a care home. However, 16% spent >170 of the 180 days at home. Significant predictors for poor outcomes were co-morbidity, nutrition, cognitive function, reduction in activities of daily living ability prior to admission, behavioural and psychiatric problems and depression. Only 42% of survivors recovered to their pre-acute illness level of function. Clinically significant behavioural and psychiatric symptoms were present at follow-up in 71% of survivors with baseline cognitive impairment, and new symptoms developed frequently in this group. Conclusions: the variable, but often adverse, outcomes in this group implies a wide range of health and social care needs. Community and acute services to meet these needs should be anticipated and provided for.
International Journal of Geriatric Psychiatry, 1991
This study examines the point prevalence of psychiatric morbidity in patients admitted to acute geriatric care, the performance of screening questionnaires in detecting psychiatric morbidity and the relationship between psychiatric morbidity and outcome (in terms of length of hospital admission and mortality) after controlling for severity of physical illness. In a sample of 119 consecutive admissions, 65 (61%) of the 106 patients assessed had dementia, while nine (10%) of the 88 assessed had a diagnosis of depression and a further 35 (40%) significant depressive symptoms, and 22 (20%) of the 106 assessed had delirium. Screening with the Mini-Mental State Examination had 81% sensitivity and 83% specificity for dementia. The Geriatric Depression Scale (GDS) had 74% sensitivity and 72% specificity for depressive symptoms; both the GDS and General Health Questionnaire had 100% sensitivity for depressive illness. Mortality was significantly higher in the delirious (62%) than in the non-delirious (14%, p<O.OOl) and in the severely demented (65%) than the mildly demented (29%) and non-demented (15%, p<O.OOl) subjects. For delirium this effect was found to be independent of the severity of physical illness. Patients with severe dementia had significantly longer hospital admissions (p < 0.02). No relationship was found between depression and outcome. KEY WORDS-Dementia, delirium, depression, general hospital psychiatry, old age, mental disorders. Although dementia only affects a minority of elderly people in the community (1% of those aged 65-74 years, rising to 10% in the over-75s (Ineichen, 1987)), it appears to be much commoner in institutions. In a survey of old people's homes in an inner London borough, Mann and colleagues (I 984) found that over a third of the residents had mild to moderate cognitive impairment and a further 31% severe dementia.
Psychiatric morbidity and acute hospitalization in elderly people
International Psychogeriatrics, 2006
Background: Few studies have investigated the association of psychiatric morbidity with acute hospitalization risk in elderly people.Method: We examined this association using population-based data for 1092 older adults aged ≥60 years in Singapore, including subjects who reported at least one acute hospitalization from any medical condition(s) in the 12 months prior to interview (N = 136). Psychiatric morbid/comorbid disorders were diagnosed using the Geriatric Mental State examination.Results: In a multivariate analysis, comorbid psychiatric disorders were inde-pendently associated with hospitalization [adjusted odds ratio 2.76, 95% confidence interval 1.20–6.33], after controlling for age, ethnicity, employment status, number of medical comorbidities, number of activities of daily living limitations, hearing and visual impairment, SF-12 Physical and Mental Component Summary scores, social, productive, fitness and health activities, and regular visits to health-care providers. Neit...
Outcome of admission to an acute psychiatric facility for older people: A pluralistic evaluation
International Journal of Geriatric Psychiatry, 1994
In this pilot study we sought to find brief, usable, reliable and valid measures of outcome from a variety of viewpoints for older adults admitted to hospital with depression or dementia. We examined patients', carers', primary nurses', consultants' and general practitioners' perceptions of outcome using a variety of measures. For the depressed patients we used nurse-rated change on the Montgomery Asberg Depression Rating Scale (MADRS) as the main outcome measure. Adequate data for analysis were collected on 24 depressed and 16 demented patients. In the depressed group there was a highly significant improvement on the MADRS. Factor analysis of the scales used produced four factors. The MADRS and the depression subscale of the Hospital Anxiety Depression (HAD-D) were strongly weighted on the first factor, the GPs' linear analogue scale on the second, the Selfcare-D (and the HAD-D) on the third and the anxiety subscale of the HAD (HAD-A) on the fourth. The HAD, which is brief and easy to use, and the GPs' linear analogue are suggested for further evaluation as routine outcome measures for depressed elderly people. For demented patients carers' rating of resolution of perceived problems is tentatively suggested for further investigation.
Characteristics of elderly people using the psychiatric emergency system
Psychiatry and Clinical Neurosciences, 2009
We investigated the differences between elderly and under-65-year-old patients using the psychiatric emergency system. The following characteristics were more common in elderly patients than in younger patients: organic mental disorder, mood disorder, dementia, disturbed consciousness, no excitation, physical complications, no history of visiting a psychiatrist and no history of hospitalization. In addition, significantly more elderly patients with mood disorder attempt suicide.
The prevalence of psychiatric illness in acute geriatric admissions
International Journal of Geriatric Psychiatry, 1993
The prevalence of psychiatric illness among 100 elderly medical inpatients was determined using the Geriatric Mental State Schedule, in its Community Version. Due to the difficulties in assessing this group of patients, less than half of those admitted could be included in the study. The diagnostic cases identified were in three groups: organic brain disease (chronic brain failure), depression, and anxiety. Depression was found in 23%, anxiety in 7% and organic brain disease in 13%.
Bulletin of Clinical Psychopharmacology, 2015
The evaluation of mental status of elderly patients presenting to emergency services and the comparison between the last diagnosis and their complaints Introduction: The number of geriatric patients presenting to the emergency department increases every year. In addition, it is known that the mental status of geriatric patients may deteriorate as they age. In the emergency department, one of the main premises of patient management is anamnesis. However, impairments in mental status of geriatric patients decrease the reliability of anamnesis. In this study, we aimed to determine the mental status of elderly patients who presented to the emergency department, the relationship between mental status and patients' complaints, and last diagnoses and mortality. Materials and Methods: The study was planned to be prospective. The mental status of geriatric patients who presented to the emergency department was evaluated with a six-question screening test. Complaints, final diagnosis information, hospitalization department, duration of hospitalization, judicial status and mortality information were recorded. Consistency between patients' complaints and symptoms determined in physician examination was evaluated. Symptom-finding consistency levels based on mental status were compared. Kappa tests for consistency assessments and chi-square test for intergroup comparisons were used. Findings: The match between patient complaints and final diagnosis of 755 patients was evaluated by two independent specialist physicians. As a result of the six-question screening test, a mismatch between patient complaint and final diagnosis was found in 16.2% of 204 patients with abnormal screening tests (n=33) compared to 0.4% of 551 patients, who had a normal screening test (n=2). Mortality was found to be 9.8% in patients with abnormal test results while it was found to be 2.0% in patients with normal screening tests. Conclusion: Mental status variance determined in elderly patients appears to be a risk factor in terms of mortality. Complaints in geriatric patients having mental status variance can be deceptive in terms of pointing to the current disease. Exploring this relationship in detail with further studies should be considered, in order to make a significant contribution to the service provided to this patient group.