Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226, Thônex, Switzerland.
Quality of Care Service, University Hospital of Geneva, Geneva, Switzerland.
BMC Psychiatry. 2021 Feb 8;21(1):82. doi: 10.1186/s12888-021-03095-4.
Coercion in psychiatry is legally tolerated as a last resort. The reduction of the use of coercion is a shared goal of hospital administrators, medical and nursing staff and representatives of patients and families but requires the identification of risk factors for coercion. These risk factors in geriatric psychiatric inpatient settings are not well known, especially regarding seclusion. Through examining the prevalence of coercion and patients' characteristics, this study aims to identify risk factors for coercion in elderly people.
The use of coercion in the geriatric psychiatry division of Geneva University Hospital in 2017 was retrospectively analyzed. The incidence rate ratios were estimated with multivariable Poisson regressions to assess risk factors for coercion.
Eighty-one of 494 patients (16.4%) experienced at least one coercive measure during their stay (mainly seclusion). The risk factors for coercion were younger age, male gender, being divorced or married, cognitive disorders, high item 1 of the Health of the Nation Outcome Scales (HoNOS) score (overactive, aggressive, disruptive or agitated behavior) at admission, previous psychiatric hospitalizations and involuntary referrals from the emergency department. Other disorders and global HoNOS scores were not associated with the use of coercion.
Higher risks of coercion were outlined in men with cognitive disorders, agitated behaviors, and previous psychiatric hospitalizations. They differed from those observed in younger adults in terms of age, civil status, disorders, global HoNOS scores and referrals. Therefore, geriatric psychiatric populations should be specifically investigated for the development of interventions aiming coercion reduction.
在精神病学中，强制手段在法律上被允许作为最后的手段。减少强制手段的使用是医院管理人员、医疗和护理人员以及患者和家属代表的共同目标，但需要确定强制手段的风险因素。这些风险因素在老年精神病住院环境中并不为人所知，特别是关于隔离的风险因素。通过检查强制手段的使用情况和患者的特征，本研究旨在确定老年人中强制手段的风险因素。
回顾性分析了 2017 年日内瓦大学医院老年精神病科的强制手段使用情况。使用多变量泊松回归估计发病率比值，以评估强制手段的风险因素。
在 494 名患者中，有 81 名（16.4%）在住院期间至少经历了一次强制措施（主要是隔离）。强制手段的风险因素包括年龄较小、男性、离异或已婚、认知障碍、入院时健康国家结局量表（HoNOS）评分的第 1 项较高（过度活跃、攻击、破坏或激动行为）、以前的精神病住院治疗和急诊部门的非自愿转诊。其他障碍和全球 HoNOS 评分与强制手段的使用无关。
具有认知障碍、激动行为和以前精神病住院治疗的男性强制手段的风险较高。他们与年龄较小的成年人在年龄、婚姻状况、障碍、全球 HoNOS 评分和转诊方面存在差异。因此，应特别针对老年精神病患者群体进行研究，以制定减少强制手段的干预措施。
