Detecting psychogeriatric problems in primary care: factors related to psychiatric symptoms in older community patients

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Abstract:

Objective: The aim was to determine the relationship and influence of different variables on the psychiatric symptomatology of older people who reside in the community, as detected by family practitioners.

Design: A cross-sectional and multi-centre study.

Setting: Twenty-eight general practices and two psychiatric practices in Huesca, Spain, from 19 primary care health centres.

Subjects: A sample of 324 patients aged over 65 years, representative of the older people who reside in the community in the province of Huesca.

Main outcome measures: Symptoms of depression (Yesavage GDS), cognitive impairment (MMSE), anxiety (GADS), psychotic symptoms, obsessive symptoms and hypochondriacal ideas (GMS) were measured by family practitioner and were detected following specific questions from the Geriatric Mental State (GMS-B) examination, following DSM-IV criteria, being defined as 'concern and fear of suffering, or the idea of having a serious disease based on the interpretation of somatic symptoms'. Sociodemographic, physical and somatic, functional and social data were evaluated. Analysis was carried out in three phases: univariate, bivariate and multivariate with logistic regression.

Results: At the time of the study, 46.1% of the older people studied suffered from some psychiatric symptom; 16.4% had cognitive impairment, 15.7% anxiety, 14.3% depression, 6.1% hallucinations and delusions, 7.2% hypochondriacal ideas and 4.4% obsessive symptoms. Female gender was significantly associated with depression (prevalence ration (PR) 3.3) and anxiety (PR 3.9). Age was a factor associated with cognitive impairment (PR 4.4). Depression was significantly related to severity of the physical illness (PR 61.7 in extremely severe impairment). Isolation (PR 16.3) and being single (PR 13.4) were factors which were strongly associated with anxiety; living in a nursing home was associated with psychotic symptoms (PR 7.6).

Conclusions: Severity of physical illness, isolation, living in a nursing home and female gender, among others, are related to psychiatric symptoms in community-residing older people identified in primary healthcare centres.

Keywords: ASSOCIATED FACTORS; OLDER PEOPLE; PRIMARY HEALTH CARE; PSYCHIATRIC SYMPTOMS; SCREENING

Document Type: Research Article

Affiliations: 1: Unidad de Salud Mental 'Pirineos'. Hospital 'San Jorge', Instituto Aragonés de Ciencias de la Salud (I+CS), Huesca, Spain 2: Unidad Docente de Atención Primaria, Instituto Aragonés de Ciencias de la Salud (I+CS), Fundación Agustín Serrate, Huesca, Spain 3: Unidad Docente de Atención Primaria, Instituto Aragonés de Ciencias de la Salud (I+CS), Huesca, Spain 4: Departamento de Psicología Básica, Clínia y Psicobiología, Universitat Jaume I, Castalló de la Plana, Spain

Publication date: March 1, 2011

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