[Reasons for referral to a gerontopsychiatric department].
Klinik für Psychiatrie und Psychotherapie, Vivantes Klinikum Hellersdorf, Myslowitzer Strasse 45, 12621 Berlin. Der Nervenarzt
(Impact Factor: 0.79).
The need of specific gerontopsychiatric wards has not been estimated thus far, although psychiatric disorders are very common among the elderly.
The purpose of this study was to describe reasons for referral of old patients to a psychiatric department providing full services for 252,000 inhabitants.
All 975 admissions within 2 years were evaluated in this prospective study.
During the study period 645 patients aged over 64 years were admitted 830 times to the gerontopsychiatric wards. About half of them were referred by physicians in private practice, about 30% came via the emergency room, and 18% were transferred from other departments or hospitals. The most frequent reasons for referral were disorientation, confusion, or delirious states (31.9%), hallucinations or delusion (21.6%), aggression or excitation (17.7%), depression (17.6%), refusal of feeding or drinking (14.4%), agitation or restlessness (13.9%), suicidality or suicide attempt (13.3%), and disruptive behaviour (13.0%). In 81.8% of the cases, behaviour endangering themselves or others was an important cause of referral. The amount of specific gerontopsychiatric beds needed in hospital was estimated as ten beds per 10,000 inhabitants aged 65 or more.
The greatest proportion of the patients referred to gerontopsychiatric wards showed behaviour endangering themselves or others-typical indications for psychiatric inpatient treatment.
Available from: Jagdish Khubchandani
- "Currently, there are no guidelines or recommendations concerning the indication for inpatient psychiatric admission   . Factors unique to each patient may lead to different treatment strategies. "
[Show abstract] [Hide abstract]
ABSTRACT: Background. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. Methods. Data was collected on patients 65 years of age or older arriving at the ER of a large urban hospital in the USA (January 2009-December 2010). Results. Of the total subjects (n = 95) included in the study, majority were females (66.3%) with an average age of 75.5 years. The chief complaint for psychogeriatric patients coming to the ER was delirium (61.6%). Caucasians were significantly more likely than African-American patients to get a psychiatric consult (33% versus 9%). Patients with delirium were less likely than patients with other psychiatric complaints to get a psychiatric consult in the ER (1.2% versus 47.2%) and less likely to be referred to a psychiatric inpatient unit compared to patients with other psychiatric complaints (2.4% versus 16.7%). Conclusion. Even though delirium is the most common reason for ER visits among psychogeriatric patients, very few delirium patients got a psychiatric consultation in the ER. A well-equipped geriatric psychiatry unit can manage delirium and associated causes.
Available from: Umut Altunoz
- "Agitation impairs patient and caregiver quality of life (Shin et al. 2005), and increases caregiver burden (Matsumoto et al. 2007). Furthermore, it causes an increase in medication use (especially antipsychotics) (Selbaek et al. 2008), early institutionalization (Kunik et al. 2010; Yaffe et al. 2002), and the frequency of hospitalizations (Wetterling et al. 2008). As such, in recent years the importance of the assessment and effective management of agitation in dementia patients, as well as cognitive symptoms, has increased (Cohen-Mansfield et al. 2010). "
[Show abstract] [Hide abstract]
ABSTRACT: The aim of this study was to investigate the dimensions of agitation in dementia patients using the Turkish version of the Cohen-Mansfield Agitation Inventory (CMAI-T).
The study included 100 patients diagnosed as dementia, according to the DSM-IV-TR. The CMAI-T was administered to the patients' caregivers via face-to-face interviews. The Standardized Mini Mental State Examination (SMMSE) was used to assess cognitive functions. The severity of depression and the functional state of the patients were assessed using the Cornell Scale for Depression in Dementia (CSDD) and the Functional Activities Questionnaire (FAQ). Principal component analysis and varimax rotation were used to determine the factor structure of the CMAI-T.
Factor analysis of the CMAI-T indicated a 3-factor structure: physically aggressive agitation, verbal agitation, and physically non-aggressive agitation. In 92% of the patients there was ≥1 agitation behavior during the previous 2 weeks. The CMAI-T total and factor scores were negatively correlated with the SMMSE scores, and positively correlated with the CSDD and the FAQ scores.
The CMAI-T yielded 3 factors (physically aggressive agitation, verbal agitation, and physically non-aggressive agitation), which indicated the scale had construct validity. Agitation behaviors were associated with cognitive dysfunction, symptoms of depression and general level of functioning. Additional research is necessary to identify the predictors of these dimensions in different dementia samples, and to determine the efficacy of therapeutic interventions.
- "Agitation / aggression is the most common BPSD (Cohen-Mansfield et al., 1989; Zuidema et al., 2007), and is associated with early institutionalization (Yaffe et al., 2002), frequent hospitalization (Wetterling et al., 2008) and decreased quality of life for both patients and caregivers (Shin et al., 2005). Decreased job satisfaction (Gruber-Baldini et al., 2004), increased professional burden (Dunkin and Anderson-Hanley, 1998) and increased risk for burn-out (Takai et al., 2008) have been observed in caregivers treating agitated / aggressive patients. "
[Show abstract] [Hide abstract]
ABSTRACT: To investigate the efficacy of animal-assisted therapy (AAT) on symptoms of agitation/aggression and depression in nursing home residents with dementia in a randomized controlled trial. Previous studies have indicated that AAT has beneficial effects on neuropsychiatric symptoms in various psychiatric disorders but few studies have investigated the efficacy of AAT in patients suffering from dementia.
Of 65 nursing home residents with dementia (mean [standard deviation] age: 81.8 [9.2] years; mean Mini-Mental State Examination score: 7.1 [0.7]), 27 matched pairs (N = 54) were randomly assigned to either treatment as usual or treatment as usual combined with AAT, administered over 10 weekly sessions. Blinded raters assessed cognitive impairment with the Mini-Mental State Examination, presence of agitation/aggression with the Cohen-Mansfield Agitation Inventory, and depression with the Dementia Mood Assessment Scale at baseline and during a period of 4 weeks after AAT intervention.
In the control group, symptoms of agitation/aggression and depression significantly increased over 10 weeks; in the intervention group, patients receiving combined treatment displayed constant frequency and severity of symptoms of agitation/aggression (F1,48 = 6.43; p <0.05) and depression (F1,48 = 26.54; p <0.001). Symptom amelioration did not occur in either group.
AAT is a promising option for the treatment of agitation/aggression and depression in patients with dementia. Our results suggest that AAT may delay progression of neuropsychiatric symptoms in demented nursing home residents. Further research is needed to determine its long-time effects.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.