45 Functional neurological disorder in geriatric rehabilitation: incidence, clinical presentations, and impact on discharge

Abstract

Background/Aims Functional neurological disorder (FND) may be present amongst elderly people in hospital. FND could hinder patients’ rehabilitation progress and impact negatively on discharge outcomes. Little data exist for FND in the elderly. We aimed to report the incidence of FND, clinical presentations, co-morbidities, and impact of FND on discharge in elderly patients receiving inpatient rehabilitation. Methods In our retrospective case series, a consultant geriatrician reviewed electronic case notes of consecutive discharges from a 28-bed geriatric rehabilitation unit at St John’s Hospital, which serves all patients requiring inpatient rehabilitation in West Lothian—a mixed rural and urban area with a population of 1 80 000 and high levels of deprivation. Data collected: demographics, suspected/definite diagnosis of FND and its presentation, significant co-morbidities and impact on discharge. Results We reviewed case notes of 100 patients discharged consecutively from 30/3/2018 to 30/10/2018 (age range 41–101, mean 79, SD 11; 55% men). 20% received a diagnosis of suspected or definite FND. FND diagnosis was made by a geriatrician (17%) or a neurologist (3%). Clinical description of FND cases and their co-morbidities will be presented in a summary table. Of the 20 FND cases (mean age 77, SD 14), 9/20 (45%) were men. FND impacted on discharges in 13/20 (8/20 had delayed discharge, 5/20 had increased care needs, 7/20 had no impact on discharge). Conclusion Key finding FND was common amongst elderly patients receiving inpatient rehabilitation. FND presentations were varied. Patients with FND also had chronic conditions common in the elderly e.g. Parkinson’s disease, stroke, dementia, anxiety or depression. Weakness and strength of our study Assessor bias might be introduced as diagnosis was made by a geriatrician with an interest in neuropsychiatry. Our data are likely generalisable to the geriatric rehabilitation population as sample was obtained from the only unit that served the entire population of West Lothian. Implications for future research and practice FND presents a unique challenge in the geriatric population. Geriatricians are not accustomed to assessing and managing FND, sometimes dismissing symptoms as ‘behavioural’. This can lead to symptoms remaining unexplained and untreated. Specialist neurology or neuropsychiatry services are not always available. The identification of FND and its effective treatment during rehabilitation could have potential impact on hospital length of stay and associated cost. Further research in FND in the elderly is needed. Better education would raise awareness of FND amongst geriatricians and thus its identification in clinical practice.