Objective: To estimate the structure and rates of psychiatric and general medical illnesses (morbidity) in a subgroup of elderly treated in a large psychiatric hospital in Riga in 2001.
Design: A descriptive study was performed on a sample of patients consecutively admitted to a gero(somato)psychiatric unit (30 beds) during a one-year period.
Material and Methods: Data were taken from hospital statistical records of discharged/died patients. Hospital records provided for up to two psychiatric and three general medical diagnoses coded according to clinical version ICD-10. Baseline data included age, gender, marital status, living arrangement, number of diseases, type of hospitalization and length of hospital stay. Of the total (n=274) number of patients 95.62% (n=262) had valid statistical records and were included in the study. Women comprised 94.27%, patients 65 + comprised 85% of the population studied. Patients under age 65 suffered from various general medical conditions, including infections. 80% of patients had only one admission. The majority (64.7%) lived in Riga with their families, about 1/3 lived alone, and 1/5 of all patients were invalids. Emergencies due to acute psychosis accounted for 41.2% of admissions. Average length of stay was about 40 days. Mortality was 24.4%.
Results: Sample mean age was 74.5 years. The leading psychiatric diagnosis was dementia (48.8%), while schizophrenia and spectrum disorders, delirium and mood disorders accounted for 18.7%, 13.7% and 9.54% respectively. Unlike the total population based worldwide statistical data, the sample proportion in Riga of chronic dementia reveals a threefold prevalence of vascular dementia (VD=34.7%) compared to dementia of the Alzheimerís type (DAT=12.2%). High rates (12.6%) of F20 diagnosis are associated with cases of early- and mid-life onset complicated by general medical conditions. Chemical abuse and dependency had 1.2% of patients. Suicide attempts = 3.2% and were associated with adjustment disorder (3.8%). The main general medical conditions were cerebrovascular disease (48% or more when considered along with general arteriosclerosis), cardiovascular (up to 37%) and pulmonary disease (up to 22%). A number of common diagnoses were underrepresented in the study due to limitations in the format of medical statistical recording forms.
Conclusions: The (inverted) ratio of VD and DAT rates in this geriatric clinical sample may reflect limited availability of radiological and neuropsychological assessment, specific aspects of patientsí clinical conditions (e.g., many individuals with advanced forms of dementia complicated by BPSD), and perhaps a conservative bias in diagnosis. This finding is consistent with the observed hierarchy of general medical conditions led by cerebrovascular disease and general arteriosclerosis. Length of stay and high mortality rates point to insufficient medical and psychiatric services for older adults. In the absence of studies in Latvia based on the geriatric population, the data in this survey may help in the design of future psychogeriatric studies, and they can be used to improve the quality of assessment of older adults in the local area.
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