Geriatric psychiatry liaison programme in a Singapore public hospital geriatric ward setting: descriptive and evaluation study on delirium and dementia

Abstract

Background: Comprehensive geriatric psychiatry liaison services are in early and evolving stages in Singapore. A description and evaluation of a geriatric psychiatry liaison programme in geriatric wards was undertaken describing programme activity and clinical outcomes in patients with neurocognitive disorders. Dementia training and staff upskilling are also discussed. Methods: This study included all referred patients by the geriatric team in Changi General Hospital over a one-year period from 15 June 2017 to 14 June 2018. As measures of good clinical practice, diagnosis of delirium and new diagnosis of dementia made during the inpatient admission following liaison consultation were included in the study. Patient-related outcomes that included length of stay (LOS), institutionalisation rates and in-hospital mortality were evaluated. Results: Dementia (53%), delirium (49%) and depression (28%) were the commonest diagnoses in this study. Dementia was newly diagnosed in 30% of cases. The median LOS in those with delirium was 19 days; 19% with a delirium diagnosis had new institutionalisation rates. In-hospital mortality in this study was 2%. Conclusions: The geriatric psychiatry liaison programme in geriatric wards in Changi General Hospital improved detection rates of delirium and new diagnoses of dementia. It also reports increased LOS and new institutionalisation rates in those with a diagnosis of delirium. Nursing staff education in neurocognitive disorders is enhanced. This article has outlined the importance of team-based care, joint specialist care and staff training in recognition of delirium and dementia in an acute hospital setting to improve outcomes for older patients.