Abstract
Background: Adult general and old age psychiatrists at Fremantle Hospital provide an integrated consultation-liaison service to general medical and surgical wards at Fremantle Hospital through referral to a consultation-liaison nurse who then allocates according to an agreed algorithm. Patients over 65 years old within Fremantle are referred to psychiatry of the elderly (POTE). All other patients are seen by adult general psychiatrists.
Aim: To describe the characteristics of patients referred to the integrated service, the respective proportions seen by adult general and POTE psychiatrists and describe any differences between patients dealt with by either group of psychiatrists.
Method: The following data were collected on all patients: ICD 10 diagnosis, source and destination of referral, demographic characteristics and number of times seen.
Results: 443 were referred to the service in 1999 with a mean age of 27.5 (range of 15–95). 230 (51.7%) were female. 216 (49%) of the population were 65 or over of whom 153 patients were seen by POTE. Adult general psychiatrists saw the remaining 30% of those over 65. In terms of medical diagnosis, deliberate self-harm (DSH) was the commonest problem (16%) followed by trauma (15%), and neurological disorders (12%). As regards psychiatric diagnoses, 151 patients (34%) had major depression followed by 23% with adjustment disorder (N = 101). Acute or chronic brain syndromes accounted for another 19% (N = 82). Non-affective psychoses, bipolar affective disorder accounted for only 20 patients each (less than 5%). 42% of patients seen by POTE had major depression (n = 64). Acute or chronic brain syndromes were the next commonest diagnoses (N = 56). Patients seen by POTE were 5 times more likely to have dementia (95% confidence intervals (CI) of 2.6 to 10.3), and 50% more likely to have major depression (95% CI = 1.1–2.5). Other disorders more likely to be seen by POTE were endocrine conditions, cardiovascular disorders and respiratory disease. They were a tenth as likely to see patients with DSH (95% CI = 0.07–0.4). There was no significant difference in other diagnoses between the two sub-specialties. 83% of patients were seen by a nurse (N = 393) and just under half by a doctor (N = 181). Most were seen on only one occasion (N = 270). 3.5% (N = 15) required from 6 to 12 attendances. 94% of patients (N = 415) referred on one occasion during the year the remaining 6% (N = 68) were referred from 2 to 4 times. In terms of outcome, 5 patients died (1%), 34 were admitted to a psychiatric unit (12%), 30% were referred to their GP, and 17% to an adult general community team. Only 0.5% were referred to a private psychiatrist. The remainder were followed-up by other agencies, or no further action was indicated.
Conclusions: Patients over the age of 65 account for a considerable proportion of cases referred to Consultation-Liaison Psychiatry and they were statistically more likely to have dementia or affective disorder than those under the age of 65. Although this suggest that this population would benefit from specialist advice from POTE, one third of patients who are 65 or over were seen still by adult general psychiatrists.