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Improving quality of care: focus on liaison old age psychiatry

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Abstract:

Introduction: Elderly patients occupy up to 65% of acute hospital beds and a significant proportion of them present with a comorbid psychiatric condition such as depression, delirium or dementia. Liaison old age psychiatry (LOAP) services have been developed to provide psychiatric consultation in medical and surgical settings, improving at the same time the knowledge and expertise of general ward staff.

Objective: The aim of this study is to evaluate clinical characteristics across different psychiatric disorders among elderly patients in medical wards.

Method: A prospective observational study was developed between October 2011 and January 2013, which involved 107 subjects aged 65 years or older that were hospitalised in the Department of Internal Medicine and referred to the LOAP service. Psychiatric diagnostic was assessed using the Confusion Assessment Method, the Geriatric Depression Scale, the Mini-Mental State Examination and the Clinical Global Impression Scale.

Results: Delirium (40.6%), depression (22.4%) and dementia (20.4%) were the most common psychiatric diagnoses. Patients with delirium were significantly older, had more severe psychiatric symptomatology (mean CGI = 5.35) and presented infectious processes as acute medical conditions more frequently than the other patients. Conclusion Psychiatric disturbances occurring in elderly inpatients in medical wards are highly prevalent and complex. A LOAP service may play an important role in effectively reducing the over-utilisation and consumption of health resources through early recognition of these conditions, effective management and prevention of adverse outcomes, and effective communication with outpatient clinics, community mental health teams and day-care centres.

Keywords: DELIRIUM; GERIATRIC PSYCHIATRY; LIAISON

Document Type: Research Article

Affiliations: 1: Psychiatry trainee, Psychogeriatric Unit, Department of Psychiatry, Coimbra University Hospital Centre, Portugal 2: Psychiatrist, Psychogeriatric Unit, Department of Psychiatry, Coimbra University Hospital Centre, Portugal 3: Psychiatrist, Clinical Head, Psychogeriatric Unit, Department of Psychiatry, Coimbra University Hospital Centre, Portugal

Publication date: October 1, 2013

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