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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 ,
C. Power ,
R. Owens  and
B. Lawlor
L. Wilson*
Affiliation:
Department of Old Age Psychiatry, St. James’s Hospital, Dublin, Ireland
C. Power
Affiliation:
Department of Old Age Psychiatry, St. James’s Hospital, Dublin, Ireland
R. Owens
Affiliation:
Department of Old Age Psychiatry, St. James’s Hospital, Dublin, Ireland
B. Lawlor
Affiliation:
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: lornaswilson@yahoo.co.uk)
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Abstract

Objective

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

Methods

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.

Results

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%.

Conclusions

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.

Keywords

Deliriumdementiageriatric psychiatrynursing homesreferral and consultation
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 36 , Issue 2 , June 2019 , pp. 121 - 127
Copyright
© College of Psychiatrists of Ireland 2017 

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References

Bellelli, G, Morandi, A, Davis, DH, Mazzola, P, Turco, R, Gentile, S, Ryan, T, Cash, H, Guerini, F, Torpilliesi, T, Del Santo, F, Trabucchi, M, Annoni, G, MacLullich, AM (2014). Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age and Ageing 43, 496–502.CrossRefGoogle ScholarPubMed
Blazer, DG (2003). Depression in late life: review and commentary. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 58, 249–265.CrossRefGoogle ScholarPubMed
BMJ Group (2007). How safe are antipsychotics in dementia? Drugs and Therapeutics Bulletin 45, 81–85.CrossRefGoogle Scholar
Callegari, CM, Menchetti, M, Croci, G, Beraldo, S, Costantini, C, Baranzini, F (2006). Two years of psychogeriatric consultations in a nursing home: reasons for referral compared to psychiatrists’ assessment. BMC Health Services Research 6, 73.CrossRefGoogle Scholar
de Lange, E, Verhaak, PF, van der Meer, K (2013). Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. International Journal of Geriatric Psychiatry 28, 127–134.CrossRefGoogle ScholarPubMed
Fossey, J, Ballard, C, Juszczak, E, James, I, Alder, N, Jacoby, R, Howard, R (2006). Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. British Medical Journal 322, 756–761.CrossRefGoogle Scholar
Goldman, LS, Klugman, A (1990). Psychiatric consultation in a teaching nursing home. Psychosomatics 31, 277–281.CrossRefGoogle Scholar
Health Information and Quality Authority (HIQA) (2009). National quality standards for residential care settings for older people in Ireland (https://www.hiqa.ie/reports-and-publications/standards/previous-national-quality-standards-residential-care-settings). Accessed 3 October 2016.Google Scholar
Inouye, SK (1998). Delirium in hospitalized older patients: recognition and risk factors. Journal of Geriatric Psychiatry and Neurology 11, 118–125.CrossRefGoogle ScholarPubMed
Janus, SI, van Manen, JG, IJzerman, MJ, Zuidema, SU (2016). Psychotropic drug prescriptions in Western European nursing homes. International Psychogeriatrics 28, 1775–1790.CrossRefGoogle ScholarPubMed
Jongenelis, K, Pot, AM, Eisses, AM, Beekman, AT, Kluiter, H, van Tilburg, W, Ribbe, MW (2003). Depression among older nursing home patients: a review. Tijdschrift voor Gerontologie en Geriatrie 34, 52–59.Google ScholarPubMed
Kramer, D, Allgaier, AK, Fejtkova, S, Mergl, R, Hegerl, U (2009). Depression in nursing homes: prevalence, recognition, and treatment. International Journal of Psychiatry in Medicine 39, 345–358.CrossRefGoogle ScholarPubMed
Leo, RJ, Sherry, C, DiMartino, S, Karuza, J (2002). Psychiatric consultation in the nursing home: referral patterns and recognition of depression. Journal of Psychosomatic Research 53, 783–787.CrossRefGoogle Scholar
Loebel, JP, Borson, S, Hyde, T, Donaldson, D, Van Tuinen, C, Rabbitt, TM, Boyko, EJ (1991). Relationships between requests for psychiatric consultations and psychiatric diagnoses in long-term-care facilities. The American Journal of Psychiatry 148, 898–903.Google ScholarPubMed
McGrath, AM, Jackson, GA (1996). Survey of neuroleptic prescribing in residents of nursing homes in Glasgow. British Medical Journal 312, 611–612.CrossRefGoogle ScholarPubMed
Meagher, DJ, Trzepacz, PT (2000). Motoric subtypes of delirium. Seminars in Clinical Neuropsychiatry 5, 75–85.Google ScholarPubMed
Mittal, D, Majithia, D, Kennedy, R, Rhudy, J (2006). Differences in characteristics and outcome of delirium as based on referral patterns. Psychosomatics 47, 367–375.CrossRefGoogle ScholarPubMed
Murphy, J, O’Keeffe, ST (2008). Frequency and appropriateness of antipsychotic medication use in older people in long-term care. Irish Journal of Medical Science 177, 35–37.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2010). Delirium: prevention, diagnosis and management (https://www.nice.org.uk/guidance/cg103). Accessed 3 October 2016.Google Scholar
Reichman, WE, Coyne, AD, Borson, S, Negron, AE, Rovner, BW, Pelchat, RJ, Sakauye, KM, Katz, P, Cantillon, M, Hamer, RM (1998). Psychiatric consultation in the nursing home. A survey of six states. The American Journal of Geriatric Psychiatry 6, 320–327.Google ScholarPubMed
Shaw, C, McCormack, B, Hughes, CM (2016). Prescribing of psychoactive drugs for older people in nursing homes: an analysis of treatment culture. Drugs – Real World Outcomes 3, 121–130.CrossRefGoogle ScholarPubMed
Tariot, PN, Podgorski, CA, Blazina, L, Leibovici, A (1993). Mental disorders in the nursing home: another perspective. The American Journal of Psychiatry 150, 1063–1069.Google ScholarPubMed
Taylor, D, Paton, C, Kapur, S (2015). The Maudsley Prescribing Guidelines in Psychiatry, 12th edn. Wiley Blackwell: London.Google Scholar
Teresi, J, Abrams, R, Holmes, D, Ramirez, M, Eimicke, J (2001). Prevalence of depression and depression recognition in nursing homes. Social Psychiatry and Psychiatric Epidemiology 36, 613–620.CrossRefGoogle ScholarPubMed
Tiong, WW, Yap, P, Huat Koh, GC, Phoon Fong, N, Luo, N (2013). Prevalence and risk factors of depression in the elderly nursing home residents in Singapore. Aging & Mental Health 17, 724–731.CrossRefGoogle ScholarPubMed
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar