Supervisors info:
Δουζένης Αθανάσιος, Καθηγητής , Ιατρική Σχολή, ΕΚΠΑ
Γουρνέλης Ρωσσέτος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μιχόπουλος Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: the age group of people that are 65 years old and over is constantly growing worldwide. The need for proper management and treatment of the mental health problems that these individuals face has led to the creation of psychiatric geriatrics. In Greece, the infrastructure with beds for the elderly that suffer from mental disorders is limited. Dementia, psychotic disorders, emotional disorders, substance abuse disorders, anxiety disorders, personality disorders and suicidal ideation are the most common disorders that can lead to compulsory hospitalization. The legislation and the rates of involuntary hospitalization vary between European Union countries. In Greece, involuntary admission is defined by law 2071/92. Involuntary admission can lead to a violation of the patient’s rights and freedom, in a longer hospital stay, increases the risk of re-admission, affects the patient’s relationship with the family environment and the treating physician, increases the risk of suicide and contributes to reduced functionality. In addition, patients who are hospitalized involuntary do not differ significantly in psychopathology from patients who are hospitalized voluntarily , but there are differences in compliance with treatment. Important prognostic factors for the duration of hospitalization are the diagnostic category, the older ages, the physical and psychiatric comorbidity, the presence of a caregiver, the drug side effects and the falls during hospitalization.
Scope: the purpose of this research is to investigate, for a period of one year, all the admissions of patients aged 65 and over, in two hospitals in the prefecture of Attica that admit patients of this age group. Thus, the factors that can lead to involuntary hospitalization and consequently longer hospitalization time can be investigated.
Methodology: a retrospective study was performed on 321 patients aged 65 and over, who were hospitalized with the procedure of involuntary or voluntary admission for the year 2019. In the Gemelio department of Attica’s psychiatric hospital, named dromokaitio and in the psychiatric clinic of University General Hospital Attikon. The diagnostic category to which the patients belonged, the duration of hospitalization, the existence of suicidal ideation and the existence of psychiatric comorbidity were recorded. As part of the analysis, the 2x2 Pearson chi-square test, the 2x5 Pearson chi-square test and the multiple linear regression were used: a) for the correlation between sex and method of admission, b) for the correlation between diagnostic category and method of admission, c) for the correlation between hospital admission and method of admission, d) to investigate the method of admission as the strongest prognostic factor for the duration of hospitalization, in relation to age, gender, hospital, the presence of suicidal ideation, psychiatric comorbidity and diagnostic category according to ICD-10.
Results: out of the 298 patients who were treated at Dromokaitio, 61.7% were treated by the involuntary hospitalization procedure, while out of the total of 23 patients treated at Attikon, 26.1% were treated involuntary. The results also showed that there is no statistically significant relationship between the method of admission and the gender. Out of the 111 patients in the ICD-10 diagnostic category for schizophrenia, schizotypal and delusional disorder, 72.1% were hospitalizes involuntary. Moreover, out of the 104 patients who belonged to the diagnostic category of organic disorders, 71.2% were involuntarily hospitalized. In contrast, 84 patients who belonged to the diagnostic category of emotional disorders, 64.3% were voluntarily hospitalized. Patients who were involuntarily hospitalized had o mean length of stay 53.41 days (SD= 111.01), while patients who were voluntarily hospitalized had an average of 27.50 days (SD= 60.7). Finally, the method of hospitalization was found to be the most important prognostic factor for the duration of hospitalization of psychiatric geriatric patients in relation to gender, age diagnostic category, hospital, the presence of suicidal ideation and psychiatric comorbidity.
Conclusion: the results found in the present study are in line with most of the cases investigated as well as with the literature about involuntary admission. However, the hypothesis which investigates the relationship between sex and the method of hospitalization was rejected. Last but not least, the investigation of the factors that can lead to involuntary admission in this age group, as well as the results of involuntary hospitalization in these patients is important.
Keywords:
Involuntary admission, Psychiatric geriatrics, Consequences of involuntary admission, Legislation of involuntary admission, Predictors of length of stay
