title: Identifying elders with neuropsychiatric problems in a clinical setting.
abstract: OBJECTIVE
  Multiple health problems among the elderly necessitate a comprehensive enquiry to detect problems early and also initiate treatment. We utilized available validated instruments to comprehensively identify older persons with neuro-psychiatric problems including dementia and comorbid medical ailments in the screening desk of the geriatric clinic.
  
  
  METHODS
  Individuals aged 60 years and above seeking outpatient care at NIMHANS during a 2-year period (October 2008-September 2010) participated. We used General Health Questionnaire (12-item), AD8, questions to identify psychoses and neurological problems and a checklist of common medical ailments. A probable clinical diagnosis was made at the end by medical personnel based on ICD-10.
  
  
  RESULTS
  A total of 5,260 individuals were screened and more than one-third (36.7%) were women. About 50% had psychological distress (≥2 on GHQ-12), 20.1% had probable cognitive impairment (≥2 on AD8) and about 17% had symptoms suggestive of psychoses (≥1 on Psychoses screener). More than 65% had either a neurological or neurosurgical problems (≥1 on Neurological screener) and headache was the commonest complaint. At probable diagnosis, more than 50% had a neurological problem and over 30% had psychiatric disorders. Of these the most common psychiatric illnesses were psychotic disorders (22.0%), mood disorders (21.4%) and dementia (14.4%). The most common medical comorbidity included hypertension (36.4%), visual impairment (31.8%) and joint pains (30.5%). Nearly 80% had one or more medical comorbidity in addition to psychiatric illness. The overall set of instruments took about 15-20 minutes. It systematically and comprehensively guided in evaluating the elderly for neuropsychiatric problems and hence was collated to constitute the Instruments for Comprehensive Evaluation of the Elderly (ICE-E).
  
  
  CONCLUSIONS
  ICE-E was brief, easy to administer and improved decision making even by personnel from a non-medical background. The instrument aided in systematically detecting neuro-psychiatric problems among the elderly (including psychological distress and cognitive changes) and other medical comorbidities.
authors.affiliation: Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Sadanand
authors.forename: Prafulla
authors.initials: P
authors.lastname: Shivakumar
authors.forename: N
authors.initials: N
authors.lastname: Girish
authors.forename: Santosh
authors.initials: S
authors.lastname: Loganathan
authors.forename: Bhavani Shankara
authors.initials: BS
authors.lastname: Bagepally
authors.forename: Lakshmi Narayanan
authors.initials: LN
authors.lastname: Kota
authors.forename: Nalini Narayana
authors.initials: NN
authors.lastname: Reddy
authors.forename: Palanimuthu Thangaraju
authors.initials: PT
authors.lastname: Sivakumar
authors.forename: Srikala
authors.initials: S
authors.lastname: Bharath
authors.forename: Mathew
authors.initials: M
authors.lastname: Varghese
keywords: Comorbidity; elderly; instruments screening; mental health; neuro-psychiatric problems