Geriatric psychiatry liaison programme improves diagnoses of delirium, dementia in older adults

The collaborative geriatric psychiatry liaison programme in a Singapore public hospital geriatric ward has resulted in better detection rates of delirium and new diagnoses of dementia, according to a recent study. Length of stay (LOS) and new institutionalization rates have also increased among those with a diagnosis of delirium.

Additionally, the programme has improved nursing staff education in neurocognitive disorders through unified psychiatrist and psychologist classroom training using case-based learning and formulation approaches. [Proc Singapore Healthc 2019;28:266-273]

“The geriatric psychiatric liaison programme described in this study further complements provision of care of older adults with delirium and dementia in geriatric wards and complements improved care delivery,” the researchers said.

The most common diagnosis was dementia (53 percent), followed by delirium (49 percent) and depression (28 percent). This finding was consistent with the reported literature on common psychiatric conditions affecting hospitalized older patients. [BJPsych Bull 2018;42:30-36]

Dementia was newly diagnosed in 30 percent (31/102) of the patients and mild cognitive impairment in 89 percent (34/38). Moreover, the median LOS in those diagnosed with delirium was 19 days, and 19 percent of patients with a delirium had new institutionalization rates. In-hospital mortality stood at 2 percent.

A review by Livingston and colleagues suggested that clinicians must consider case finding for dementia in hospitalized older adults to improve management and clinical outcomes. However, an Irish national audit study found several deficiencies, including poor cognitive assessments and paucity of dementia care pathways in hospitalized older adults. [Lancet 2017;390:2673-2734; lenus.ie/bitstream/handle/10147/312996/reportdementiacareacutehospitals2014.pdf]

In the current study, the most common reason for hospital admission was falls in the community, followed by sepsis and behavioural disturbances. In a recent systematic review and meta-analysis, multicomponent nonpharmacological delirium interventions were found to effectively reduce incident delirium and rate of falls, with a trend towards reducing LOS and preventing institutionalization. [Am J Geriatr Psychiatry 2018;26:1015-1033]

“Geriatric inpatient stay is an opportunity to identify, address and manage multifactorial causes for falls in hospitalized older adults,” the researchers said. “Additionally, preventative strategies for inpatient falls could be undertaken through increased detection rates of dementia.” [Clin Interv Aging 2013;8:1101-1108]

The present study included all referred patients by the geriatric team in Changi General Hospital over a 1-year period from 15 June 2017 to 14 June 2018. Diagnoses of delirium and dementia made during the inpatient admission following liaison consultation were included as measures of good clinical practice. The researchers then assessed patient-related outcomes, such as LOS, institutionalization rates and in-hospital mortality.

“Early and accurate detection of mental health issues is the foundation for healthy ageing, and this article has outlined the importance of team-based care, joint specialist care and staff training in recognition of delirium and dementia in an acute hospital setting to improve outcomes for older patients,” the researchers said.

“This descriptive study reports findings, measures of good practice and discharge outcomes in relation to delirium and dementia, which hopefully will rekindle audits and research to further improve outcomes in neurocognitive disorders,” they added.