Some predictors of psychiatric consultation in nursing home residents.
OBJECTIVE
Despite the high rate of psychiatric disorders in nursing homes, research indicates that psychiatric consultation is requested infrequently. The authors sought to determine the rate of psychiatric consultation in a nursing home population and to assess what factors were related to a consultation request.


METHODS
Subjects were recruited from a stratified random sample of 59 nursing homes across Maryland. All new admissions age 65 years and older from September 1992 through March 1995 were eligible for the study. A total of 2,285 subjects were included in the study. Variables examined were factor scores from the Cornell Scale for Depression in Dementia and the Psychogeriatric Dependency Rating Scale (Behavioral Subscale), nursing home characteristics, and whether the resident had a psychiatric consultation within 90 days of admission.


RESULTS
Twenty percent of the residents (N=404) had a psychiatric consultation. There was no significant association with demographic variables. Behaviors that triggered a psychiatric consultation included agitation, physical/verbal abuse, wandering, and manic/destructive acts. A psychiatric consultation was also requested when residents displayed anxiety. Surprisingly, depression in retarded and psychotic residents did not trigger a psychiatric consult.


CONCLUSIONS
As expected, behavioral problems and agitation are common reasons for a psychiatric consultation. However, the resident who is depressed, particularly the quiet or retarded depressed resident, may be overlooked. In this context, it is important for the nursing staff to recognize that lethargy and social withdrawal may be signs of depression, and a referral to a psychiatrist may be in order.
Fenton
Joanne
J
Mental Health Service Line, Veterans Affairs Maryland Health Care Center, Baltimore, MD 21201, USA.
Raskin
Allen
A
Gruber-Baldini
Ann L
AL
Menon
A Srikumar
AS
Zimmerman
Sheryl
S
Kaup
Bruce
B
Loreck
David
D
Ruskin
Paul E
PE
Magaziner
Jay
J
D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology* / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009483:Neuropsychological Tests; D009735:Nursing Homes; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000453:epidemiology; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012918:Social Alienation / Q000523:psychology; D011795:Surveys and Questionnaires; D014705:Verbal Behavior