Am J Psychiatry 1991; 148:898-903
Copyright © 1991 by American Psychiatric Association
Relationships between requests for psychiatric consultations and psychiatric diagnoses in long-term-care facilities
JP Loebel, S Borson, T Hyde, D Donaldson, C Van Tuinen, TM Rabbitt and EJ Boyko
Residential Care Unit, Harborview Community Mental Health Center, Seattle, WA 98104.
OBJECTIVE: The authors' objective was to investigate reasons for referral
of elderly nursing home residents for psychiatric consultation and the
relationship of these reasons for referral to psychiatric diagnoses.
METHOD: They examined 197 nursing home residents consecutively referred to
a consulting team in a university-affiliated mental health center. These
patients represented all patients evaluated by the consulting team at six
nursing homes over a 2-year period (Sept. 1, 1984, through Aug. 30, 1986).
RESULTS: Reasons for referral were diverse but fell into seven broad
clusters: behavioral problems; mood- related problems; consultations
requested by involuntary treatment services, patients, physicians, or other
referring agencies; psychotic features; physical signs; impaired activities
of daily living; and other. Behavioral problems were most commonly cited
and tended to be associated with dementia diagnoses. Mood-related reasons
for referral were most strongly associated with diagnoses of affective
disorders, and diagnoses of schizophrenia and adjustment disorder were each
associated with two or more reasons for referral. However, reasons for
referral were distributed widely across diagnostic groups and were
relatively weak predictors of diagnoses. CONCLUSIONS: The results
illustrate the variety of problems for which nursing home staff are willing
to seek psychiatric consultation but emphasize the need for professional
psychiatric evaluation to establish a diagnostic base on which treatment
interventions can be built.
