PSYCHOGERIATRIC CONSULTATION SERVICES - EFFECT AND EFFECTIVENESS

Objectives: To determine the nature of referrals to a psychogeriatric consultation/outreach service, the types of interventions provided, an d the effects and effectiveness of the service. Method: The study used a prospective approach in which 67 consecutive patients referred for psychogeriatric assessment were followed up 6 to 8 weeks after the ini tial assessment and then again 6 months after initial contact. Patient s were rated at the time of referral and at follow-up on presence of p sychiatric diagnosis, need for institutional care, and placement outco me. Results: Of the 67 patients initially seen, 51 (76%) experienced m emory problems and 46 (69%) had depressed mood. Consistent with this f inding, 36 (54%) were diagnosed by consultants as having a dementia, a nd 15 (22%) received a diagnosis of depression. The most frequent reco mmendations included medication changes in 34 cases (50%) and further assessments in 37 cases (55%). Although information at 6-week follow-u p was available for only 58% (n = 38) of the sample, 18 (46%) patients were generally improved. Interestingly, only 12 (31%) of referring ph ysicians indicated that they had followed the advice of the consultant s. Cognitive impairment and depressive symptoms were major concerns am ong referring physicians. The most common recommendation made involved pharmacotherapy. While compliance of family doctors to recommendation s made was poor, patients improved over time. Patients requiring inpat ient assessment were very old, living alone, experiencing behavioural problems, and not depressed. Conclusions: Psychogeriatric consultation s appear most useful in cases where patients are more severely affecte d and/or are suffering from a greater range of symptoms.