Two years of psychogeriatric consultations in a nursing home: reasons for referral compared to psychiatrists' assessment

Abstract

BackgroundIn spite of the high prevalence of psychiatric disorders among elderly residents in nursing homes, only a small number of patients in need of specialist care are referred to a psychiatric consultant. The aim of this research was to evaluate the consultation activity and the appropriateness of referral to psychiatric assessment.MethodsData were collected and analysed on consultation carried out over a two-year period in a RSA (Residenza Socio-Assistenziale) in Northern-Italy. Data were catalogued with reference to: patients, consultation, diagnosis and recommended medications. Statistical correlation analysis by means of Spearman test and signification test was carried out.ResultsResidents referred to psychiatric consultation at least once were 112 (14.5% of all residents). Reason for referral were: depression (17.2%), delusions and hallucinations (14%), agitation (34.8%), aggressive behaviour (23.5%) and disturbances of sleep (6.8%). Most frequent diagnoses were organic, including symptomatic, mental disorders (33.9%), mood disorders (22.3%) and schizophrenia, schizotypal and delusional syndromes (18.8%). No psychiatric diagnosis was found only in 1.8% of cases, thus confirming high sensibility of referring physicians.A statistically significant correlation was found when comparing referrals for depression or delusions and allucinations or sleep disturbances and diagnostic confirmation of such symptoms by specialistic assessment (respectively 49.8%, 52.7% and 19.6%).Correlation between psychotic symptoms and the consequent prescription of antipsychotic drugs had a significant if somewhat modest value (24%) while correlation between depression symptoms and prescription of antidepressant drugs was more noticeable (66.5%).ConclusionMain reason for referral to psychiatric consultation resulted to be the presence of agitation, a non-specific symptom often difficult to attribute. Data concerning depression confirm tendency to underestimating this diagnosis in the elderly. Furthermore, symptomatic reasons for referral did not always correspond to subsequent diagnostic definitions by psychiatric consultants, therefore demonstrating modest predictive power.

Reasons for psychiatric consultation referrals in Dutch nursing home patients with dementia: a comparison with normative data on prevalence of neuropsychiatric symptoms

“…Although this procedure enabled us to mimic psychiatric consultation as it happens in everyday clinical practice, it also means that our data on referrals are not exactly the same as estimates of actual symptom prevalence. Nevertheless, our findings are consistent with those of others (Rovner et al, 1990;Loebel et al, 1991;Shea et al, 1994;Leo et al, 2002;Callegari et al, 2006), which may imply that by and large validity is not challenged.…”

“…That study did not specify apathy as a separate behavioural change category. An Italian study in residential care facilities showed that psychiatric referrals were associated with symptoms of depression (17.2%), psychosis (14%), agitation (34.8%), aggression (23.5%) and sleep disturbances (6.8%) (Callegari et al, 2006). A large scale study showed that nursing home residents who stole, hurt themselves, exposed themselves or hallucinated were more likely to receiving specialist mental health services (Shea et al, 1994).…”

“…While age and impairment of Activities of Daily Living (ADL) predict not receiving treatment from a mental health professional (Shea et al, 1994), depression, psychosis and agitation are positively associated with having received treatment (Loebel et al, 1991;Shea et al, 1994;Fenton et al, 2004;Callegari et al, 2006). Notably, nursing home staff often fails to recognize depression (Leo et al, 2002;Callegari et al, 2006).…”

“…Usually, there is a need for receiving diagnostic and medication recommendations, advice on nonpharmacologic management techniques, staff support, and dealing with staff stress and family conflicts (Reichman et al, 1998). Reasons for consultation are distributed widely across diagnostic groups and may be relatively weak predictors of psychiatric diagnoses (Loebel et al, 1991;Callegari et al, 2006). Up until now no study examined primary reasons for psychiatric consultation in nursing home patients with dementia and compared referrals to normative data on prevalence estimates of neuropsychiatric symptoms.…”

The association of individual and facility characteristics with psychiatric hospitalization among nursing home residents

“…However, less than half received other outpatient behavioral health services. While the reason for underutilization of behavioral health services for any one individual is unknown, the general finding of underutilization of behavioral health services in nursing home settings has been well documented (Reichman et al, 1998;Callegari et al, 2006). Reported reasons for this include lack of access, inadequate resources, inadequate reimbursement rates, or staff attitudes toward NH residents with mental health disorders (Reichman et al, 1998;Hsu et al, 2004;Callegari et al, 2006).…”