Lund-Heimark Hallvard, Kjelby Eirik, Mehlum Lars, Gjestad Rolf, Selbæk Geir, Kroken Rune Andreas, Johnsen Erik, Oedegaard Ketil Joachim, Mellesdal Liv S
Research Department, Division of Psychiatry, Haukeland University Hospital, Norway.
National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
BJPsych Open. 2020 Jun 18;6(4):e63. doi: 10.1192/bjo.2020.45.
The common recommendation that adults with onset of mental illness after the age of 65 should receive specialised psychogeriatric treatment is based on limited evidence.
To compare factors related to psychiatric acute admission in older adults who have no previous psychiatric history (NPH) with that of those who have a previous psychiatric history (PPH).
Cross-sectional cohort study of 918 patients aged ≥65 years consecutively admitted to a general adult psychiatric acute unit from 2005 to 2014.
Patients in the NPH group (n = 526) were significantly older than those in the PPH group (n = 391) (77.6 v. 70.9 years P < 0.001), more likely to be men, married or widowed and admitted involuntarily. Diagnostic prevalence in the NPH and PPH groups were 49.0% v. 8.4% (P < 0.001) for organic mental disorders, 14.6% v. 30.4% (P < 0.001) for psychotic disorders, 30.2% v. 55.5% (P < 0.001) for affective disorders and 20.7% v. 13.3% (P = 0.003) for somatic disorders. The NPH group scored significantly higher on the Health of the Nation Outcome Scale (HoNOS) items agitated behaviour; cognitive problems; physical illness or disability and problems with activities of daily living, whereas those in the PPH group scored significantly higher on depressed mood. Although the PPH group were more likely to report suicidal ideation, those in the NPH group were more likely to have made a suicide attempt before the admission.
Among psychiatric patients >65 years, the subgroup with NPH were characterised by more physical frailty, somatic comorbidity and functional and cognitive impairment as well as higher rates of preadmission suicide attempts. Admitting facilities should be appropriately suited to manage their needs.
65岁后出现精神疾病的成年人应接受专门的老年精神病治疗这一普遍建议，所依据的证据有限。
比较既往无精神病史（NPH）的老年人与既往有精神病史（PPH）的老年人中与精神科急性入院相关的因素。
对2005年至2014年连续入住综合成人精神科急性病房的918名65岁及以上患者进行横断面队列研究。
NPH组（n = 526）患者的年龄显著大于PPH组（n = 391）患者（77.6岁对70.9岁，P < 0.001），男性、已婚或丧偶以及非自愿入院的可能性更大。NPH组和PPH组中，器质性精神障碍的诊断患病率分别为49.0%对8.4%（P < 0.001），精神障碍为14.6%对30.4%（P < 0.001），情感障碍为30.2%对55.5%（P < 0.001），躯体障碍为20.7%对13.3%（P = 0.003）。NPH组在《国家健康结果量表》（HoNOS）的激越行为、认知问题、躯体疾病或残疾以及日常生活活动问题项目上得分显著更高，而PPH组在情绪低落方面得分显著更高。虽然PPH组更有可能报告有自杀意念，但NPH组患者在入院前更有可能有过自杀未遂行为。
在65岁以上的精神科患者中，NPH亚组的特点是身体更虚弱、躯体合并症更多、功能和认知障碍以及入院前自杀未遂率更高。收治机构应适当满足他们的需求。
