Socio-demographic and Clinical Characteristics of Older Patients Transferred from a Consultation Psychiatry Service to Geriatric Psychiatry Inpatient Units

Abstract

<h3>Introduction</h3> Consultation Psychiatry Services in general hospitals regularly encounter medical-surgical inpatients whose psychiatric co-morbidities necessitate transfer to psychiatric inpatient settings. To our knowledge, limited data exist on such transfers, with even less known about <i>geriatric psychiatry</i> transfers. <h3>Methods</h3> Billing record review determined the proportion of older (≥ 65 years) patients seen by Consultation Psychiatry from 1/1/21 - 8/30/21. Number of such patients transferred to a geropsychiatry inpatient unit were identified through the referral field in our EHR. Chart reviews abstracted sociodemographic and clinical characteristics of transfers. Patients were excluded if they had been transferred <i>from</i> psychiatry inpatient to medical-surgical inpatient and then back to psychiatry; or if they had been transferred from medical-surgical inpatient to psychiatry and then back to medical-surgical because of medical decompensation. Only patients who completed their geriatric psychiatry inpatient stay were included. A consensus assessment between two geropsychiatry evaluators (AV, BG) rated "active" versus "inactive" psychiatric treatment by consultation psychiatrists based on psychopharmacological management, efforts to facilitate ECT treatment where indicated, and re-evaluation prior to transfer. Relationships between key variables and geriatric psychiatry inpatient median lengths of stay (LOS) were evaluated by Mann-Whitney U tests with p-values determined. <h3>Results</h3> From 1/1/21 – 8/30/21, the Consultation Psychiatry service evaluated 1517 individuals, of whom 46% were over age 65 years. Sixty-seven (8.7%) of these patients were transferred to geriatric psychiatry units, which represented 32% of all admissions during that period. Descriptive analyses excluded patients meeting back-and-forth transfer criteria sequentially described above (n = 17 and n=12). Remaining patients (n = 38) comprised the final sample. Mean age of the transferred sample was 75.6 years (SD = 6.79; range = 65-92). 68.4% were women and 31.6% men. Two-thirds of the sample identified as White (68.4%), while 7.9% were Black, 10.5% Hispanic, and 10.5% Asian. 42.1% were married, 18.4% single, 18.4% divorced, and 13.2% widowed. Most patients (81.6%) had at least one child. Over two-thirds (71.1%) lived in a private home with a family member, 13.2% lived at home alone, and 13.2% resided in a nursing home or assisted living facility. The majority of patients (78.9%) were discharged to a private residence, with the remaining group (21.1%) discharged to a structured living facility. Of primary psychiatric diagnoses, 26.8% had a psychotic disorder, 41.8% had a major depressive disorder, 13.4% had bipolar disorder, and 17.9 % had a neurocognitive disorder with concomitant behavioral disturbances. "Active" psychiatric treatment (as defined above) by consultation psychiatrists during medical-surgical hospital stay occurred in approximately two-thirds (68.4%) of patients destined for transfer to geriatric psychiatry. Median length of stay (LOS) in geriatric psychiatry for the entire group was 22.0 (+/- SD 21.4) days. Relationships between median LOS and sociodemographic/clinical variables revealed the following statistically significant findings. Women had a median LOS of 25 (+/- 24.3) days whereas men had a median LOS of 16 (+/- 10.4) days (p < 0.0001). Patients living at home prior to medical-surgical admission had a median geriatric psychiatry unit LOS of 21.0 (+/- 20.1) days as compared to patients who were living in a nursing home or assisted living facility who had a median LOS of 35.0 (+/- 20.9) days (p < 0.0005). Patients discharged home had a median LOS of 20.0 (+/-11.1) days while patients discharged to any structured living facility for seniors had a median LOS of 38.0 (+/- 32.7) days (p < 0.0001). <h3>Conclusions</h3> Nearly half of consultation psychiatry patients were over age 65 years, suggesting geropsychiatric training/expertise in general hospital psychiatry is critical, especially since less than 10% of patients ended up transferred for specialty geropsychiatric inpatient care. Furthermore, that nearly a third of geropsychiatry inpatients emanated from consultation psychiatry and that a third of patients destined for transfer had ‘inactive' treatment during medical-surgical stays further supports closer interactions of consultation and geriatric psychiatry services. The diagnostic breakdown of transfers appeared representative of geropsychiatry inpatients not referred from medicine, however validation awaits comparisons. Gender differences in LOS may be explained by additional analysis of psychosocial/clinical profiles of men and women in this sample. The significantly longer LOS in patients coming from and being discharged to nursing homes or assisted living facilities suggests clinical complexity that should catalyze early disposition planning for such patients. <h3>This research was funded by</h3> N/A