Pattern of referrals to a community-based psycho-geriatric assessment service: a 9 year review. (1994)

SUMMARY A review of 856 referrals to a community-based psychogeriatric assessment service (St James Settlement) from October 1984 to October 1993 showed female predominance (female to male 3:1) and average age of 75 years old. A high degree of illiteracy was found. Non-medical referrals constitute almost all referrals to the centre throughout the 9 years of study. Presenting problems for consultation were mainly related to common psychiatric disorders in the old age like dementia and depression. Dementia usually presented with behavioural and memory disturbance. Depressed patients complaint more commonly with disturbance in mood, anxiety and insomnia. Although a relatively high default rate (38.7%) was found, one third of the remaining patients showed considerable benefit from the service. The limitations of the existing service and implications on future development were discussed. Keywords: psychogeriatrics, community, referral, diagnosis INTRODUCTION With the advance of medical care in the general population, it is evident that the proportion of aged population increased rapidly. An estimate in USA revealed a growth of population over 65 from 4% of the general population at the turn of the century to over 12% of the population in the 1980s. The projected figure will reach more than 60 millions (over 20% of general population) by the year 2030 (Besdine, 1987). As elderly population is the major user in health care, the emphasis in medical practice had shifted from prevention and treatment of acute diseases to managmerd of chronic degenerative disorders. Psychogeriatrics is one area which demand special attention as psychiatric disorders in late life constitute a significant part in psychiatric practice. Various studies showed that about 496 to 6% of the elderly population suffered from some farms of demendng disorder (Goo, et al, 1993; Burns, 1940). Increasing demands for psychoger-latric referrals in UK was shown by a rise of 150% from 1974 do 1984 (Christie & Wood, 1987). Mainprize & Rodin (1987) reported geriatric referrals consitituted 29% of all psychiatric referrals to a consultation-liaison service in Canada. Improved specificity to psychogeriatric liaison referrals was observed with increase in awareness of pslehogeriatric service as a special need (Anderson et al, 1988). Coupling with a downward trend in the mortality rate of very elderly demented, there has been considerable implication on psychiatric service provision for the elderly (Blessed, 1982; Christie, 1982; Christie & Train. 1984), In the present study, we attempted to analyse the referral pattern to psychogeriatric assessment service at St. James Settlement (SJS), SJS is a mull-purpose community centre located centrally on Hong Kong island run by a voluntary agency. A psychogeriatric assessment clinde jointly run by SJS and Departrnent of Psychiatry, University of Hong Kong had been in operation since October 1984. Visiting psychiatrists from the urdversity attended the clinic on weekly basis. In order to facilitate referrals from caregivers, referrals from all sources, including self-referral, were accepted. The benefits of taidng non-medical referrals in psychogenatrics had been highlighted by other audwrs before (Harris et al, 1990; Lippert et al, 1990). Each patient underwent an initial psychiatric assessment and treatment plans were formulated accordingly. Apart from clinical assessment, SJS also run a multi-disciplinary community-based service for the elderly. It involved courmlling, support groups, geriatric day care centre and meal services. As evaluation on psychogerlatric services had consistently demonstrated benefits on community and multidisciplinary approaches (Wasylenld et al, 1984; Hard-Thompson, 1992; Collighan et al, 1993), we beLved that the experience of a pioneer psychogeriatric project at St. James Settlement will be beneficial for service planning in this area. Review on the pattern of referrals for the past 9 years (1984-1993) vas reported as folkws and potential implications were discussed. …