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Psychiatric consultation in the nursing home: reasons for referral and recognition of delirium

Published online by Cambridge University Press:  10 November 2017

L. Wilson*
Department of Old Age Psychiatry, St. James’s Hospital, Dublin, Ireland
C. Power
Department of Old Age Psychiatry, St. James’s Hospital, Dublin, Ireland
R. Owens
Department of Old Age Psychiatry, St. James’s Hospital, Dublin, Ireland
B. Lawlor
Department of Old Age Psychiatry, St. James’s Hospital, Dublin, Ireland
*Address for correspondence: L. Wilson, Department of Old Age Psychiatry, Martha Whiteway Day Hospital Day, MISA, St James’s Hospital, James Street, Dublin 8, Ireland. (Email:



To describe the behavioural and psychiatric problems found in nursing home psychiatric referrals in the Dublin South city area.


We undertook two consecutive surveys of nursing home referrals to the St James’s Hospital psychiatry of old age service over a 2-year period. During the second survey a new clinical nurse specialist was specifically appointed to manage the seven nursing homes included in the study.


The most common reason for referral during survey one was uncooperative/aggressive behaviour (22%). For survey two, patients were most commonly referred for low mood (31%) or agitation (29%). During survey one, the majority of patients assessed were diagnosed with behavioural and psychological symptoms of dementia (41%). This was also a prevalent diagnosis during survey two, affecting 27% of those referred. Only 7% of patients were considered to be delirious during survey one. This rose to 31% the following year making it the most common diagnosis during survey two. Over the 2-year study period, 7% of referred patients were diagnosed with depression. In terms of prescribing practices, the discontinuation rate of antipsychotic mediation following psychiatric input was 13% in survey one. By survey two, this had risen to 47%.


Delirium is often undetected and untreated in nursing homes. Residents presenting with psychiatric symptoms should undergo routine bloods and urinalysis prior to psychiatric referral. Dedicated input from trained psychiatric nursing staff can lead to both an improvement in the recognition of delirium and reduced prescribing rates of antipsychotic medication.

Original Research
© College of Psychiatrists of Ireland 2017 

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