A Comparison between Demographic and Clinical Characteristics of Younger and Older Elderly New Referrals to an Out-Patient Psychogeriatric Service

Article excerpt

Abstract: We compared the demographic and clinical characteristics of 37 subjects under and 41 subjects over 75 years of age who were consecutive new referrals to an out-patient psychogeriatric service in order to examine if an age-related dichotomy emerges in this population. Even though the groups were similar in most demographic (gender, education, years in Israel, family status) and some clinical aspects (number of physical diagnoses, medications taken) they differed significantly in some other clinical variables. "Functional" disorders, independence in performing household activities and Activities of Daily Living (ADL) and more recommendations for ambulatory follow-up were more prominent in the younger group. This profile has much in common with elderly patients newly referred to the general mental health services. The older group had more "organic" disorders, significant need for assistance in household activities and ADL, and more recommendations for follow-up in day-care centers, a profile more characteristic of patients who are treated in memory/dementia clinics. Thus, from a services organizational point of view, it is possible to subdivide out-patient elderly individuals with cognitive and emotional disturbances into separate groups, each with its own characteristics and needs.

Introduction

Services programmers in ambulatory psychogeriatrics have to deal with two central issues when only the patient's chronological age is considered. The first is concerned with the lower age limit of admittance into these services.

Traditionally, the arbitrary dichotomy of 65 years and over is the cut-off point (1). Practically, however, several questions arise with regard to the diagnostic, clinical and management complexities of those individuals younger than 65 who are afflicted by presenile dementia (2, 3) (i.e., are they "psychogeriatric" cases?) and the growing number of patients with long-standing psychiatric functional disorders who have been treated on an ambulatory basis and who reach their 65th birthday (i.e., should they be "automatically" transferred to a psychogeriatric service?) (4). The second issue encompasses possible additional cut-off points: Should all elderly individuals afflicted by cognitive and emotional disturbances be uniformly considered as simply being 65 years and older (5), or should they be subdivided into several age-related groups (e.g., "young" elderlies, "old" elderlies), each with its own clinical characteristics and management needs? Epidemiological and clinical data clearly support such heterogeneity (6, 7, 8).

The present study is concerned with this second issue. We compared demographic and clinical characteristics of elderly individuals under and over 75 years of age who were new referrals to a specialized psychogeriatric out-patient service, in order to examine if such a dichotomy emerges from such an approach within this population.

Methods

Included in this study were all new referrals for ambulatory psychogeriatric evaluation at the Psychogeriatric Center, Ichilov Hospital (Tel Aviv), during the period from 14 April to 14 June 1996. A new referral was defined as a patient who had never before attended a psychiatric service or had been treated elsewhere, or one who was treated in our service but more than one year had elapsed since the last visit (9).

Evaluations were carried out on women over 60 years old and men over 65 years old regardless of the age of onset and nature of the psychiatric disorder. Each patient was comprehensively evaluated by a multi-disciplinary team (a psychiatrist, a geriatrician, a nurse and a social worker). Laboratory and neuroimaging screening examinations are routinely requested in our institution for all cases of cognitive decline (10).

A detailed questionaire was completed for each study patient and included: a) demographic data (age, gender, country of origin, duration of stay in Israel, familial status, years of education), b) clinical data (ICD-10 [11] psychiatric diagnosis, physical diagnoses, prescription medications taken), c) functional data (whether the individual requires assistance in household activities [broadly defined by us to include several instrumental activities of daily living, IADL, in addition to housekeeping) and in the basic activities of daily living [ADL - eating, dressing, bathing, mobility and sphincter control]), d) the recommendations made, i. …