Is Consultation-Liaison Psychiatry ‘Getting Old’? How Psychiatry Referrals in the General Hospital Have Changed over 20 Years

Abstract

There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000–2019 (N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.

Diagnostic Agreement between Physicians and a Consultation–Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals

“…The high rates of referrals for delirium are in line with previous evidence that indicates an overall aging of the inpatient population in GHs and reveal a high incidence of delirium in the inpatient setting [ 35 , 36 ], a common reason for psychiatric referral [ 22 , 24 , 37 ]. The fair diagnostic accuracy found for delirium (which rose to moderate when the presentation was associated with agitation) indicates a remarkable and well-known risk that GH doctors may miss a delirium diagnosis [ 36 , 38 ], particularly in case of hypo-active delirium [ 39 ].…”

Clinical Profile and Length of Hospital Stay in a Sample of Psychogeriatric Patients Referred to Consultation Liaison Psychiatric Unit

“…Prolonged hospital stays are a major challenge for health systems and present high associated economic costs. Research has confirmed how effective CLP unit clinical actions may help improve outcome indicators of health care, i.e., quality of life and disability of patients, length of hospital stay, and health costs [ 31 ]. A rapid and effective participation of the liaison psychiatrist is therefore relevant and is aligned with the proactive model of care of a CLP unit; this participation also focuses on early psychiatric care in medical and surgical settings, which has been shown to decrease LOS [ 32 ].…”

Age-Friendly Cities and Communities: State of the Art and Future Perspectives

“…For this Feature Paper Special Issue entitled “ Age-Friendly Cities and Communities: State of the Art and Future Perspectives ”, a total of 29 papers [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] were recently published on different topics related to this subject matter. Of the published papers, seven papers [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ] related to age-friendly neighbourhoods, cities, communities and societies, three papers [ 29 , 30 , 31 ] explored innovative approaches to housing, two papers [ 32 , 33 ] concentrated on age-friendly transportation, four papers [ 34 , 35 , 36 , 37 ] focused on innovative practices in the domain of cure and/or care for older citizens, four papers [ 38 , 39 , 40 , 41 ] related to respect and social inclusion, and nine papers [ 42 , …”

“…The study by Ferrari et al [ 34 ] from Italy focused on age-friendly hospital care. Consultation–Liaison Psychiatry Services (CLPS) are significantly involved in providing age-friendly hospital care.…”

“…For this Feature Paper Special Issue entitled "Age-Friendly Cities and Communities: State of the Art and Future Perspectives", a total of 29 papers were recently published on different topics related to this subject matter. Of the published papers, seven papers [22][23][24][25][26][27][28] related to age-friendly neighbourhoods, cities, communities and societies, three papers [29][30][31] explored innovative approaches to housing, two papers [32,33] concentrated on age-friendly transportation, four papers [34][35][36][37] focused on innovative practices in the domain of cure and/or care for older citizens, four papers [38][39][40][41] related to respect and social inclusion, and nine papers [42][43][44][45][46][47][48][49][50] dealt with the consideration of technology in an age-friendly city or community.…”