Differences between elderly voluntary and involuntary admitted psychiatric patients in Greece

Involuntary psychiatric admission is a controversial issue with legislation varying from country to country. Research on elderly individuals being involuntary admitted has been limited. This study aims first at assessing whether elderly involuntary admitted patients (IAPs) differ with regard to demographic, psychopathological, and behavioral characteristics from voluntary admitted psychiatric patients (VAPs) and second to assess whether the former group should be treated in a different (special) way.

Forty IAPs were compared to 39 VAPs with regard to sociodemographic data, DSM-IV diagnosis, as well as behavioral issues recorded by the Patient-Staff Conflict Checklist - Shift Report (PSCC-SR). All patients were aged 60 years and over and were admitted in the psychiatric departments of four general hospitals in Athens. The study period lasted 12 months.

VAPs were more likely to be suffering from mood disorders, while IAPs presented higher rates of delirium. From the 20 items of the PSCC-SR, differences were found only in two: IAPs presented more aggressive behavior during the first few days of admission whereas VAPs had committed recent suicide attempt just before admission.

From the clinical point of view, IAPs presented with delirium and more aggressive behavior, whereas, the VAPs presented with higher rates of mood disorder and suicidality. However, from the medicolegal point of view, our findings lend support to the argument of either setting a limited time frame for involuntary admission in elderly patients, and/or allowing for elderly individuals with acute organic conditions to be treated against their will.