Risk factors for medical deterioration of psychiatric inpatients: opportunities for early recognition and prevention

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

“…For example, work performed by some of us has identified age 65 and older, increased blood urea nitrogen, and decreased haemoglobin and albumin levels as independent predictors for the large number of significant medical deteriorations occurring in patients hospitalized for psychiatric conditions. (Manu et al, 2012) In this large cohort, the medical deteriorations became manifest frequently as falls or febrile syndromes, and required often admissions to medical units. It is reasonable then to assume that biologically frail elderly patients receive a higher level of medical attention, leading to the discovery of pre-existent cardiovascular conditions prevalent in this age group.…”

Acute hospital service utilization by inpatients in psychiatric hospitals

“…The annual rate of admission of psychiatric inpatients of 16% is much higher than in other studies, both from North America, which reported that 6.8% [20] and 0.5% per annum respectively [15] of patients were transferred for general hospital admissions from standalone psychiatric hospital settings.…”

“…The 18.0% of psychiatric inpatients (N= 855) transferred to ED over the year however, is comparable to the 14.0% transferred to a general hospital setting from a psychiatric hospital over a one year period in one US study [20].…”

Medical Outcome of Patients With Dementia in a Free-Standing Psychiatric Hospital

“…A medical deterioration during inpatient psychiatric treatment may lead to life-threatening complications, interrupt behavioral, pharmacological, and electroconvulsive interventions, increase suffering, prolong length of stay, and add considerable expense to the episode of psychiatric illness. Such events are more likely in the geropsychiatric population, 1 because advanced age correlates with frailty, a state that reflects the presence of functional and cognitive decline, decreased muscle strength and endurance, and malnutrition 2 and the “geriatric syndrome” that includes falls, delirium, and syncope. 3 The elderly individuals are also vulnerable to increased cytokine activity related to stress and inflammatory disorders.…”

“…A high rate of medical deteriorations among patients with dementia admitted for behavioral disturbance has been recently identified, 1 but focused studies comparing patients with dementia with age-matched psychogeriatric control participants are lacking, despite the increasing size of this population 15,16 and the impact of their hospitalizations on national health care resources. 6…”