Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-25T07:04:43.805Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatric consultation to elderly medical inpatients in a general hospital

Published online by Cambridge University Press:  13 June 2014

Conor O'Neill ,
Henry O'Connell  and
Brian A Lawlor
Conor O'Neill
Affiliation:
St Brendan's Hospital, Rathdown Road, Dublin 7, Ireland
Henry O'Connell
Affiliation:
St James's Hospital, James's St, Dublin 8, Ireland
Brian A Lawlor
Affiliation:
St James's Hospital, James's St, Dublin 8, Ireland
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To determine the reasons for referral of elderly medical inpatients for psychiatric consultation and the appropriateness of such referrals. To determine whether the provision of a consultation service is associated with increases in referral rates over time.

Method: One hundred consecutive referrals seen over an 18-week period were included in the study and data on reason for referral, ICD-10 diagnosis and recommended interventions gathered prospectively. Rates of referral were calculated and compared with a similar study performed in the same location five years previously.

Results: In this location the most frequent reason for referral was for assessment of depressive symptoms (47%). Referrals were generally appropriate and there was a high degree of concordance between reason for referral and psychiatric diagnosis, particularly for depressive symptoms. There was a moderate (22%) increase in referral rates in the five years since the previous study. Concordance rates between reason for referral and psychiatric diagnosis had improved considerably during this period, particularly for depressive symptoms.

Conclusions: Referral rates for psychogeriatric consultation increase over time. Referrals are generally appropriate, and recognition of depressive illness improves. Psychiatric illness may still be under-recognised and increasing workload may indicate a need for more refined models of service delivery.

Keywords

ConsultationElderlyInpatientReferral
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 20 , Issue 3 , September 2003 , pp. 80 - 83
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Dublin, Ireland: Central Statistics Office, 1999.Google Scholar
2.Shah, A, Odutoye, K, De, T. Depression in acutely medically ill elderly inpatients: a pilot study of early identification and intervention by formal psychogeriatric consultation. J Aff Disord 2001; 62(3): 233–40CrossRefGoogle ScholarPubMed
3.Ames, D. Depressive disorders among elderly people in long-term institutional care. Aust NZ Psychiatry 1993; 27(3): 379–91.CrossRefGoogle ScholarPubMed
4.Rapp, SR, Parisi, SA, Wallace, CE. Comorbid psychiatric disorders in elderly medical inpatients; a one-year prospective study. J Am Geriatr Soc 1991; 39(2): 124–31.CrossRefGoogle Scholar
5.Schukitt, MA, Miller, PL and Hahlbohm, D. Unrecognized psychiatric illness in elderly medical-surgical patients. J Gerontol 1975; 30: 655–660.CrossRefGoogle Scholar
6.Bergman, K, Eastham, E. Psychiatric ascertainment and assessment for treatment in an acute medical ward setting. Age and Ageing 1974; 3: 174–188.CrossRefGoogle Scholar
7.Saravay, SM, Lavin, M. Psychiatric comorbidity and length of stay in the general hospital, A critical review of outcome studies. Psychosomatics 1994; 35(3): 233–52.CrossRefGoogle ScholarPubMed
8.Davis, PS, Holman, CD, Brameld, K. Gender differences in survival of 234 patients referred to a psychogeriatric service. Int J Ger Psychiatry 2000; 15(11): 1061–9.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
9.Popkin, MK, Mackenzie, TM, Callies, AL. Psychiatric Consultation to Geriatric Medically III Inpatients in a University Hospital. Arch Gen Psychiatry 1984; 41: 703–7.CrossRefGoogle Scholar
10.Anderson, DN, Philpott, RM, Wilson, KC. Psychogeriatric liaison referrals. Br J Psychiatry 1988; 153: 413.CrossRefGoogle ScholarPubMed
11.Freyne, A, Buckley, P, Larkin, C, Walsh, N. Consultation liaison psychiatry within the general hospital: referral pattern and management. Ir Med J 1992; 85(3): 112–4.Google ScholarPubMed
12.Folkes, DG, Ford, CV. Psychiatric Disorders in Geriatric Medical/Surgical Patients. Southern Med J 1985; 78(3):239–41.CrossRefGoogle Scholar
13.Levitan, SJ, Kornfield, DS: Clinical and cost benefits of liaison psychiatry. Am J Psychiatry 1981; 138: 790–793.Google ScholarPubMed
14.Strain, JJet al.Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients. Am J Psychiatry 1991; 148(8): 1044–1049.Google ScholarPubMed
15.Folstein, MF, Folstein, SE, McHugh, PR. A practical method for grading the cognitive status of patients for the clinician. J Psychiat Res 1975; 112: 189–198.CrossRefGoogle Scholar
16.Tombaugh, TN, McIntyre, NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40(9): 922–35.CrossRefGoogle ScholarPubMed
17.Millar, HR. Psychiatric morbidity in elderly surgical patients. Br J Psychiatr 1981; 138: 17–20.CrossRefGoogle ScholarPubMed
18.Incalzi, RAet al.Effects of hospitalization on affective status of elderly patients. Int Pychogeriatr. 1991; 3(1): 67–74.CrossRefGoogle ScholarPubMed
19.Bowman, AM. The relationship of anxiety to development of postoperative delirium. J Gerontol Nurs. 1992; 18(1): 24–30.CrossRefGoogle ScholarPubMed
20.Holmes, JD, House, AO. Psychiatric illness in hip fracture. Age Ageing 2000; 29(6): 537–46.CrossRefGoogle ScholarPubMed
21.Poynton, AM. Psychiatrc liaison referrals of elderly inpatients in a teaching hospital. Br J Psychiatry 1988; 152: 45–47CrossRefGoogle Scholar
22.Creed, F, Guthrie, E, Black, D, Tranmer, M. Psychiatric referrals within the general hospital: comparison with referrals to general practitioners. Br J Psychiatry 1993; 162: 204–211.CrossRefGoogle ScholarPubMed
23.Pauser, H, Bergstrom, B, Walinder, J. Evaluation of 294 psychiatric consultations involving in-patients above 70 years of age in somatic departments in a university hospital. Acta Psychiatr Scand 1987; 76(2): 152–7.CrossRefGoogle ScholarPubMed
24.Scott, J, Faribairn, A, Woodhouse, K. Referrals to a psychogeriatric consultationliaison service. Int J Geriatr Psychiatry 1988; 3:131–135.CrossRefGoogle Scholar
25.Grossberg, GT, Zimny, GH, Nakra, BR. Geriatric psychiatry consultations in a university hospital. Int Psychogeriatr. 1990; 2(2): 161–8.CrossRefGoogle ScholarPubMed
26.Anderson, DN, Philpott, RM. The changing pattern of referrals for psychogeriatric consultation in the general hospital: An eight-year study. Int J Geriatr Psychiatry 1991; 6: 801–807.CrossRefGoogle Scholar
27.Seltzer, A. Prevalence, detection and referral of psychiatric morbidity in general medical patients. J R Soc Med 1989; 82: 410–12.CrossRefGoogle ScholarPubMed
28.Swanwick, GR, Clare, AW, Lawlor, BA. Consultation-liaison psychiatry: A comparison of two service models for geriatric patients. Int J Geriatric Psychiatry 1994; 9: 495–99CrossRefGoogle Scholar
29.Collinson, Y, Benbow, SM. The role of the old age psychiatry consultation liaison nurse. Int J Geriatr Psychiatry. 1998; 13(3): 159–63.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
30.Baheerathan, M, Shah, A. The impact of two changes in service delivery on a geriatric psychiatry liaison service. Int J Ger Psychiatry 1999; 14(9): 767–75.3.0.CO;2-6>CrossRefGoogle ScholarPubMed