[Diagnosis and discharge destination of patients admitted for mental dysfunctioning in a geriatric department]

To determine the prevalence of psychiatric and somatic disorders and to evaluate functional status and discharge destinations of patients with impairment of mental functioning admitted to a geriatric unit of a general hospital.

Rijnstate Hospital Arnhem, the Netherlands.

Descriptive prospective study.

In 1993, 43 patients with recent impairment in mental functioning were followed. Physical illness, course of physical and psychiatric problems and discharge destination were recorded. Psychiatric diagnoses were classified according to the DSM-III-R. The 'Barthel index' for activities of daily living (ADL), 'Mini-mental state examination', 'Hamilton depression scale' and 'delirium rating scale' were used in evaluation of functional status and mental functioning.

All the patients had psychiatric problems (delirium 28, dementia 23, depression 6, several problems 21). Thirty-eight patients (88%) had recent physical illness, in 21 (49%) functional status was impaired (p < 0.001). In many patients improvement in mental functioning (70%), functional status (26%) and somatic condition (79%) was achieved. Improvement of the somatic condition (79%) was often (87%) accompanied by improvement of the psychiatric condition (other patients (21%): 50%, p < 0.05). Nursing home placement was needed in 53% (admitted geriatric patients in general: 13%, p < 0.001).

Most patients suffered from delirium (65%). In 23 patients (53%) dementia was diagnosed, mostly for the first time. Improvement of the somatic condition was significantly related to improvement of the psychiatric condition. Patients admitted with recent impairment of mental functioning are at greater risk to be placed in a nursing home than admitted geriatric patients in general.