|Year : 2012 | Volume
| Issue : 2 | Page : 81-85
Psychiatric co-morbidity in geriatric inpatients
Kalasapati Lokesh Kumar, Samrat Kar, Pavan K Reddy
Department of Psychiatry, Mamata Medical College and General Hospital, Khammam, Andhra Pradesh, India
|Date of Web Publication||11-Jul-2012|
Kalasapati Lokesh Kumar
Post Graduate, Department of Psychiatry, Mamata Medical College and General Hospital, Khammam, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: The prevalence of psychiatric disorders is an important area of concern in the elderly population. But, most of the psychiatric morbidity remains undetected in this age group.
Aim: To study the prevalence and pattern of psychiatric disorders in geriatric inpatients.
Materials and Methods: All the geriatric inpatients admitted in the non-psychiatric wards of Mamata General Hospital for a period of 1 month were assessed using a semi-structured interview consisting of socio-demographic details. Brief Psychiatric Rating Scale (BPRS) was used to screen for psychotic and non-psychotic symptoms. Mini Mental Status Examination (MMSE) was used to screen for cognitive decline. The diagnosis was made according to ICD-10 diagnostic criteria.
Results: Out of 120 patients, 48 (40%) had psychiatric illness. Psychiatric disorders were more common among females and in patients living in nuclear families. Depression was found to be the most common (25%) illness.
Conclusion: This study emphasizes the importance of co-ordination between the physicians and psychiatrists for providing better psychiatric care of the geriatric inpatients.
Keywords: Co-ordination, geriatric, in-patients, psychiatric
|How to cite this article:|
Kumar KL, Kar S, Reddy PK. Psychiatric co-morbidity in geriatric inpatients. J NTR Univ Health Sci 2012;1:81-5
| Introduction|| |
With the improved health care facilities and better availability of health services, the geriatric population is gradually on raise. But, this group of population is at increased risk of developing both physical and psychological problems due to the age-related factors and changes in the social circumstances. The association between physical and psychiatric disorders is well established by several studies. ,,, But, much of this co-morbidity remains undetected, and therefore, remains untreated. This further prolongs the duration of suffering and the outcome of the illness.
In a hospital-based study, Abhay et al. found that nearly 52.5% of the patients with chronic medical illness suffer from psychiatric illness, depression being the most common. A study by Srinivasan et al. on cognitive impairment in the medical and surgical in patients, emphasized that patients more than 70 years of age with an acute medical problem are the most likely to have cognitive problems. In a community study in elderly patients conducted by Ramachandran et al.,  there was 35% prevalence of psychiatric morbidity. Nandi et al.,  in a rural community-based study in West Bengal, found that 61% of the geriatric population needed psychiatric treatment, and women had a higher rate of morbidity than men. In a comparative study conducted by Tiwari and Srivatsava,  the prevalence of psychiatric disorders was found to be high in geriatric population (42.21%), among which, depression and anxiety disorders were most common. Only 3.97% of the non-geriatric population suffered from psychiatric illness, which was much less when compared to the prevalence in geriatric age group.
Many western studies have emphasized that there is a significant prevalence of undetected psychiatric illness among the in-patients of non-psychiatric wards in hospitals. , Schuckit et al.,  in a hospital-based study, observed that 24% of the patients who are more than 65 years, in the medical and surgical wards, had psychiatric co-morbidities among which, depression and alcohol-related disorders were predominant. Katon and Sullivan  found that 6% of the patients in primary care setting and 11% of medical in-patients have major depression, compared with 3% prevalence in general population. According to Katz and Alexopoules,  many of the depressive disorders remain undiagnosed and untreated as they are misinterpreted to be a normal part of ageing. Uwakwe  evaluated all the patients aged more than 60 years, who were admitted in non-psychiatric wards in a teaching hospital and observed that 45.3% of the patients had psychiatric illness, with depression being the commonest, followed by organic disorders, adjustment disorder, and generalized anxiety disorder. Only 2.8% of the mental disorders could be recognized by the physicians. This reflects the need for psychological assessment to be an integral part of comprehensive functional health assessment of geriatric patients.
With this background, we have conducted this study to detect the prevalence of psychiatric co-morbidities, undetected among the geriatric in-patients of non-psychiatric wards of Mamata General Hospital, Khammam.
| Aim|| |
- The prevalence of psychiatric disorders in geriatric in-patients of non-psychiatric wards
- The pattern of psychiatric illness in the geriatric in-patients
- The association of socio-demographic variables with psychiatric illness.
| Materials and Methods|| |
This cross-sectional study was done on all the geriatric in-patients admitted in non- psychiatric wards, which included all the medical and surgical departments of Mamata General Hospital. This was conducted from 1 st November 2010 to 30 th November 2010. The patients were diagnosed for their physical illness by the consultants of the corresponding departments. Those individuals with both acute and chronic illness were considered for the study.
The psychiatric assessment on the patients was conducted at least 3 days after their admission in to the hospital, so that they get adapted to the ward setup.  The purpose of study was explained, and an informed consent was taken. The interview was conducted on bedside.
Tools used for psychiatric assessment include:
Diagnoses were confirmed by the consultant of psychiatry department.
- A semi-structured interview developed in the department of psychiatry, consisting of socio- demographic details.
- Mini Mental Status Examination (MMSE).  It is a 30-point scale. Those who scored less than 24 are considered to have cognitive decline and further evaluated for Dementia.
- Brief Psychiatric Rating Scale (BPRS)  was used to screen for the presence of psychotic and non-psychotic symptoms.
- International Classification of Diseases (ICD-10) diagnostic criteria. 
- Age > 60 years.
- Availability of reliable informant.
- Patients not giving consent.
- Patients who are physically not fit for the interview.
- Patients on drugs, which could alter their cognitive functions.
| Results|| |
The initial study sample included 129 patients, out of which, 9 had to be excluded as per the fixed exclusion criteria. The final study sample was 120. Out of 120 patients, 72 (60%) had no psychiatric disorder and 48 (40%) were diagnosed to have psychiatric disorders.
[Table 1] shows the association of socio-demographic variables with psychiatric disorders. In our study, most of the individuals were in the age group of 60 to 75 years (83.3%), and the prevalence of psychiatric disorders in this age group is high when compared to the population above 75 years of age, which contributed to 16.7% of the study population. Among the 100 individuals who were in the age group of 60 to 75 years, 46 (46%) had psychiatric disorders and among the 20 who were more than 75 years, only 2 (10%) had psychiatric disorders. Males outnumbered the females and out of 80 males, 30 (37.5%) had psychiatric disorders. Among 20 females, 18 (45%) had psychiatric illness, which was comparatively more than that of males. Out of 38 patients living with spouse, 16 (42.1%) had psychiatric disorders and among 82 individuals where the spouse is absent, 32 (39.1%) were suffering from psychiatric morbidity. Among 68 individuals who were from nuclear family, 30 (44%) had psychiatric disorder. 18 (34.6%) out of 52 individuals from joint families had psychiatric illness.
The pattern of prevalence of psychiatric disorders is depicted in [Table 2]. In our study, depression was found to be the most common psychiatric disorder, present in 30 (25%) patients, followed by adjustment disorder in 8 (6.7%), and anxiety disorders in 6 (5%). Among the organic mental disorders, 4 (3.3%) of the in-patients were diagnosed to have dementia. 3 of them had Alzheimer's disease and 1 had Vascular dementia.
| Discussion|| |
This cross-sectional study is conducted to analyze the socio-demographic profile and the pattern of psychiatric disorders among the in-patients of a teaching hospital setting. The initial study sample was 129 patients out of which, 5 had to be excluded as consent was not given, which reflects the existing stigma towards psychiatry. 2 patients had no reliable informants, and 2 patients were not physically fit for the interview. The final study sample was 120.
Out of 120 patients, 72 (60%) had no psychiatric morbidity and 48 (40%) had psychiatric morbidity. This observation is similar to other studies by Tiwari et al. in rural area in Uttar Pradesh and Uwake  in a teaching hospital, in which the prevalence of psychiatric morbidities were found to be 42% and 45.3%, respectively.
One interesting finding in our study was that there is a decrease in the prevalence of psychiatric morbidity with age. 46% of the patients in the age group of 60 to 75 years had psychiatric morbidity, and 10% of the individuals above 75 years had psychiatric illness. This could be due to the absence of primary care giver in the patients with increased age, and therefore, decreased hospitalization of the patients. Small sample size is also a contributory factor for this finding. This finding is in accordance with a study by Bouza et al. in Spain population and by Gurland et al. Nandi et al.,  in a rural study, found that there is an increase in the prevalence of psychiatric morbidity with age. This difference could be due to the difference in the study population as it was a community-based study, and our study was conducted in a teaching hospital.
Out of 80 males, 30 (37.5%) had psychiatric disorder and out of 40 females, 18 (45%) had psychiatric illness. This high prevalence of psychiatric illness in females is similar to findings in other studies by Jain et al.,  and Nandi et al. This can be understood by the fact that the females in a traditional set-up like India are exposed to high family burden, and responsibility associated with stress and the presence of stress is associated with increased psychiatric illness.
There was not much difference in the prevalence of psychiatric illness among the patients with spouse (42.1%) and the patients without spouse (39.1%). This finding is similar to the findings of Nandi et al.,  Parker and Clangton.  This finding is not in accordance with the findings of a study in general population by Ramachandran et al.,  in which there is high prevalence of psychiatric illness in widows (41.2%) than in the patients with spouse (29.5%). This could be due to the difference in the study population as this is a hospital-based study.
There was an increased prevalence of psychiatric morbidity in patients from nuclear families (44.1%), compared to those from joint families (34.6%). Similar findings were reported by Niruj Agarwal and Jhingan.  This decreased prevalence of psychiatric disorders among the patients from joint families could be due to a better emotional and social support that a person gets in a joint family, compared to a nuclear family.
Depression was found to be most common psychiatric illness (25%), followed by adjustment disorder (6.7%), anxiety disorders (5%), and dementia (3.3%). Ramachandran et al. in a rural study found the prevalence of depression to be 23.6%. Various factors like loss of physical vigor, loss of occupation, friends, spouse may be the stressors as the age advances and can potentially precipitate depression.  In a study conducted in a teaching hospital by Sood et al.,  psychiatric disorders that were found among the inpatients were depression, adjustment disorders, anxiety disorders, dementia, delirium, bipolar affective disorder, and psychoactive substance use-related disorders. Bipolar-affective disorder and psychoactive substance use- related disorders were not found in our study. Though 12 individuals had the habit of taking alcohol, none of them met the criteria for any category of psychoactive substance use. This could be due to the limited sample size.
We could analyze that, about 40% of the patients admitted in the non-psychiatric wards had psychiatric disorders. This finding is in accordance with the findings by Ramachandran et al. (1979) and Seby et al. (2011) in which the prevalence of psychiatric disorders was 35% and 26.7%, respectively. With the advent of new drugs and modern treatment, there is no significant change in the prevalence of psychiatric disorders. Various factors like changing social circumstances, lifestyle changes could be responsible for this. This also emphasizes that the psychiatric awareness and support have to be improved at social and community level for which the role of psychiatrists is crucial. In our study, the psychiatric disorders among the patients in the non-psychiatric wards remained undiagnosed. Therefore, the psychiatric care in general hospital setting has also to be enhanced by adequate training of other medical professionals to recognize and refer the patients for a better geriatric care.
- The study had to be conducted in a limited time frame.
- The study was done on a sample taken from the hospital-based population; it may not be representative of the general population.
- The study population was not categorized based on duration of illness and the system involved, and the association of these factors with psychiatric illness was not assessed.
- It was a cross-sectional study, and therefore, the follow-up of the patients was not done.
- The two categories of the population are not matched; hence, conclusions are difficult to be derived.
| Conclusion|| |
- The prevalence of psychiatric illness is more in females, and in those belonging to nuclear families. Depression is the most common psychiatric illness prevalent.
- This study signifies the need for a team work of physicians and surgeons with psychiatrists for better geriatric patient care.
- There is a need for psychiatric orientation of medical and surgical faculties for early diagnosis of psychiatric illness.
- Awareness about the psychiatric disorders at the community level can potentially reduce the course and out-comes of the illness.
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[Table 1], [Table 2]
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