Retrospective Analysis of Liaison Psychiatric Service in Elderly Inpatients in A General Hospital / 中国医学科学院学报

ABSTRACT

Objective To analyze liaison psychiatric service in a geriatric ward in a big general hospital and explore the way to improve accessibility of geriatric psychiatric service in general hospitals. Methods Elderly inpatients aged 65 years old or more admitted to a geriatrics ward in Peking Union Medical College Hospital in 7 years duration (January 2008 to December 2014) were enrolled in the study. Liaison psychiatrists attended ground round combined with psychiatric consultation from January 2008 to December 2009 (T1 period). Comprehensive geriatric assessment,geriatric interdisciplinary team services and psychiatric consultation were conducted from January 2010 to December 2014 (T2 period). Consultation rate,reasons for referral,psychiatric diagnoses,length of stay,and medical expense were compared between different periods.Results Among 1230 geriatric inpatients,383 patients were enrolled in liaison psychiatric service,and 511 individual consultations happened.The consultation rate for T1 and T2 were 19.7% and 33.8%,respectively (P=0.000).The dominating reasons for referral were current emotional symptoms (30.4%) and current psychiatric symptoms (28.3%) in T1 and current emotional symptoms (65.3%) and medically unexplained symptoms (12.8%) in T2 (P=0.000). For length of stay,consultation group lasted for (199.2±40.0) days,and non-consultation group lasted for (71.3±16.6) days(P=0.004) in T1;(22.0±2.4) days and (22.6±1.6) days(P=0.834) in different groups in T2 respectively. The medical expense were (243 000±44 000) RMB for consultation group and (79 000±18 000) RMB for non-consultation group(P=0.040) in T1 and (18 000±2 000) RMB and (21 000±1 000) RMB (P=0.302) in different groups in T2 respectively. The prevalence rate for psychiatric disorders revealed by liaison psychiatrists was 15.8% in T1 and 29.8%in T2 (P=0.000) in the geriatric ward. Conclusions Elderly inpatients are vulnerable population for psychiatric disorders. Therefore,psychiatrist should be an important member in geriatric interdisciplinary team. Combination of comprehensive geriatric assessment,psychiatric consultation and geriatric interdisciplinary team is very efficient model in general hospital settings to improve the accessibility of psychiatric services in elderly in China.