Geriatric syndromes and multimorbidity in older adults with psychiatric disorders : An integrated perspective

Abstract

This thesis describes four studies on prevalence and implications of geriatric syndromes and multimorbidity (chronic health conditions) in older patients with psychiatric disorders. We found that medically unexplained symptoms (MUS) were often not as unexplained as they seemed in older adults. MUS were frequently accompanied by frailty, multimorbidity and psychiatric disorders. This intermingling made recognition of these problems difficult. It is known that the oldest old have little benefit from antidepressants when treated for a depressive disorder. We investigated whether this could be because of the geriatric characteristics of these patients, by conducting a systematic review. We found that these geriatric syndromes were barely taken into account in treatment studies on depression in older adults and that persons aged > 75 years were underrepresented. This means that the results of these studies are not applicable to many of the patients we actually have to treat. Older adults who were acutely admitted to geriatric psychiatric wards were often frail, undernourished and had a high level of multimorbidity. Frailty and multimorbidity were important factors in not being able to return home after discharge. Frailty also predicted mortality within five years after admission. Overall, this thesis shows that geriatric problems have a relevant impact on older adults with psychiatric disorders. It sheds new light on the connection between psychiatry, geriatrics and psychology and the necessity to integrate care for complex patients with psychiatric disorders.