Who Cares Wins - Royal College of Psychiatrists

12
How common is mental disorder in general hospitals?
1.8 To confidently examine the nature of mental disorder affecting older people in general hospitals a
systematic review of the literature was performed. This identified 576 studies of potential interest,
of which 97 met predefined quality criteria and were examined in detail (8-104).
1.9 The findings of this systematic review are summarised in Table 1.2. Some studies report the
prevalence of cognitive impairment without differentiating between dementia and delirium. These
studies have been carried out in different populations, different hospital specialities and using
different methods of assessment. This, probably, contributes to the wide range of prevalence for
some conditions.
Table 1.2.
The prevalence of mental disorder in older people in general hospitals.
Diagnosis
Depression
Delirium
Dementia
Cognitive
impairment
Anxiety
Schizophrenia
Alcoholism
No. of
studies
47
31
17
33
3
4
4
Total no. of
participants
14632
9601
3845
13882
1346
1878
1314
Mean
sample size
311
309
226
421
449
376
329
Prevalence
range
5-58%
7–61%
5-45%
7–88%
1-34%
1–8%
1–5%
1.10 To aid interpretation, Table 1.2 contains the mean prevalence for each condition obtained by
adding the total number of cases detected by all studies and dividing this by the total sample in all
studies. This mean prevalence is likely to represent the true prevalence of mental disorder of
older people in general hospital wards. It should be noted that depression, dementia and delirium
are much more common in general hospitals than in the community (see Table 1.1).
• depression, dementia and delirium are much more common in
general hospitals than in the community.
Mean
prevalence
29%
20%
31%
22%
8%
0.4%
3%
1.11 To put these findings into context we return to our typical general hospital. We already know that of
its 500 beds, 330 are occupied by older people at any one time. Two hundred and twenty of these
older people will have a mental disorder. 96 will have depression, 102 dementia, 66 delirium, 10
alcohol misuse and two schizophrenia (Box I). Such a general hospital will have at least four times
as many older people with mental disorder on its wards than the local mental health services have
on theirs.