ABSTRACT
To take care of elderly patients in psychiatric hospital sets specific problems. It is interesting to know the mode, the frequency, and the reasons of these hospitalizations, to improve the medical care given to these subjects. We made a prospective study with elderly patients hospitalized in a psychiatric institution. The results were completed in discussions with the medical care staff. During the study (January and February 1997), 112 elderly patients, about more than 60 years old, were hospitalized in Villejuif' specialized hospital (inpsychiatric units). Informations about social facts, main psychiatric previous, reasons of the hospitalization, the caring and the evolution of these subjects were collected. The main important reflexion we did observe was the significant difference between elderly patients hospitalized in psychiatric units, with or without psychiatric previous before the age of 60. Those who were hospitalized at the first time in psychiatric units before 60, presented a medium aged population, younger than the other group. They also presented more delusion with psychosis, were more frequently hospitalized longly in psychiatric units, took neuroleptics, and their somatic associate pathologies were less difficult to take care of. In the second group including the elderly patients without psychiatric previous before 60, we did observe very different characteristics: the diagnosis of most of the patients is dementia; these elderly subjects leaved mostly at home, they presented more sadness, aggression, or social inappropriate behaviour. Depression is a more frequent diagnosis. This study of all the elderly patients admitted in a psychiatric hospital confirmed the population's heterogeneity. The existence of an hospitalisation in psychiatric unit before sixty represented a pertinent test to a major and simple approach of these differences. The psychiatric unit which receives more and more elderly patients take care of their differences to the organisation of care needs between the gerontopsychiatric patients types. The patients with a late gerontopsychiatric's disease could need a specific hospitalization in gerontopsychiatric units, especially organised to deliver psychiatric cares and somatic cares, including medical geriatric practicer and medical care staff formed to the dependence need care.
Subject(s)
Mental Disorders/epidemiology , Patient Readmission/statistics & numerical data , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Alzheimer Disease/psychology , Chronic Disease , Delusions/diagnosis , Delusions/epidemiology , Delusions/psychology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/psychology , Female , France , Geriatric Assessment/statistics & numerical data , Humans , Life Change Events , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Middle Aged , Personality Disorders/diagnosis , Personality Disorders/epidemiology , Personality Disorders/psychology , Psychiatric Department, Hospital , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Recurrence , Risk FactorsABSTRACT
RISING INCIDENCE AND PREVALENCE: The frequency of epilepsy after the age of 60 years is increasing, a particularly important point in light of the rise in this age group. Incidence is estimated to exceed 100 cases per 100,000 subjects over the age of 60, reaching 160 per 100,000 in subjects aged 80 to 84 years. Prevalence exceeds 7 per 1000 in the 55 to 64 age group and 12 per 1000 in the 85 to 94 age group. CLINICAL FEATURES IN THE ELDERLY: Partial complex seizures are particularly frequent. Some patients experience seizure-related confusion states or slowly regressive neurological deficits. THERAPEUTIC STRATEGY: Excepting acute seizures induced by aggressive cerebral events, treatment should be aimed at the triggering factor. Anti-epilepsy drugs are warranted in patients who experience 2 or more seizures and for whom no amendable triggering factor can be identified. For stroke patients, long-term treatment should be reexamined after the acute phase. DRUG PRESCRIPTION: Benzodiazepines have proven efficacy when the objective is to achieve rapid control of frequent seizures. However, for elderly subjects, the risk of sedation and known adverse effects must be carefully assessed for these drugs. All anti-epilepsy agents are active: choosing the right drug for elderly subjects depends basically on patient tolerance and risk of drug interaction. Special attention should be given to the effect on cognitive function.
Subject(s)
Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Acute Disease , Age Distribution , Age Factors , Aged , Anticonvulsants/classification , Anticonvulsants/pharmacology , Drug Prescriptions , Drug Utilization , Epilepsy/complications , Epilepsy/epidemiology , Geriatric Assessment , Humans , Incidence , Patient Selection , Prevalence , Recurrence , Risk FactorsABSTRACT
OBJECTIVES: Thyroid disease is common in elderly subjects but as diagnosis is difficult, systematic screening is widely proposed. The clinical usefulness in terms of therapeutic impact has not been proven. PATIENTS AND METHODS: We investigated the clinical usefulness of screening for dysthyroidism using ultrasensitive TSH assay (TSHus) in 657 unselected patients hospitalized in a geriatric unit. TSHus was performed at admission in all patients and completed by a full laboratory work-up in case of abnormal results. Therapeutic decisions were recorded from the medical file. RESULTS: Mean patient age was 82 +/- 7 years, 74% were women. Prior history or current drug regimen were indications for TSHus assay in 144 patients (21.9%) who comprised group 2. In 513 other patients (group 1) the situation was one of true systematic screening. Hypothyroidism was diagnosed in 24 patients in group 1 (4.7%) and hyperthyroidism in 25 (4.9%). In group 1, few specific therapeutic measures were taken and involved only 6 patients (1.2%). Medical counseling was however provided for 37 patients (7.2%). CONCLUSION: Dysthyroidism is common in the elderly hospital population and systematic screening using TSHus is warranted at admission. However, the clinical impact of screening is minimal since few therapeutic measures are subsequently taken.
