A descriptive study of first time outpatient public psychiatric care after 65 years.
Humans
Female
Male
Cross-Sectional Studies
Aged
France
Mental Disorders
/ therapy
Aged, 80 and over
Community Mental Health Centers
/ statistics & numerical data
Referral and Consultation
/ statistics & numerical data
Community Mental Health Services
/ statistics & numerical data
Ambulatory Care
/ statistics & numerical data
Outpatients
/ statistics & numerical data
CMHC
Cross-sectional study
First consulting
France
Older adults
Psychiatric trouble
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
09 Oct 2024
09 Oct 2024
Historique:
received:
05
01
2024
accepted:
30
09
2024
medline:
10
10
2024
pubmed:
10
10
2024
entrez:
9
10
2024
Statut:
epublish
Résumé
Mental health in the older adults represents a public health issue, especially depression and suicide, and even more in the Brittany French region. Community Mental Health Centers (CMHC) are the front-line French psychiatric healthcare organizations, but the number, characteristics and trajectories of the older adults consulting there for the first time are unknown. An exhaustive cross-sectional study from medical records about first-time consultants in any CMHC of the Guillaume Régnier Hospital Center in 2019, and quantifying and describing the 65 and over ones according to socio-demographic, clinical, geographic and trajectory criteria. This population represents 9.7% of all first consulting in CMHCs. We can note that 70.5% are female, 46.8% are living alone and 31.2% are widowed. These 3 rates are higher than in the general population. The main diagnosis we found is mood disorder (35.1%). Organic mental disorders are scarce (8.2%). Most people are referred by a general practitioner (53.4%) or a specialist/hospital center (23.7%). The main referral at the end is to CMHC care (73.6%). Only 20.0% had a referral to non-psychiatric health professionals (GP, coordination support teams, geriatrics, other professionals). Significant differences in the referral at the end exist between 65 and 74, who are more referred to CMHC professionals, and 75 and over, who are more frequently referred to non-psychiatric health professionals. Significant discrepancies about who referred are found according to community area-type. These results align with the literature about known health-related characteristics and the importance of depression in the older people. They question the link with non-psychiatric professionals, and the need to structure a homogeneous care organization in psychiatric care for the older adults with trained professionals, especially for the 75 and over.
Sections du résumé
BACKGROUND
BACKGROUND
Mental health in the older adults represents a public health issue, especially depression and suicide, and even more in the Brittany French region. Community Mental Health Centers (CMHC) are the front-line French psychiatric healthcare organizations, but the number, characteristics and trajectories of the older adults consulting there for the first time are unknown.
METHOD
METHODS
An exhaustive cross-sectional study from medical records about first-time consultants in any CMHC of the Guillaume Régnier Hospital Center in 2019, and quantifying and describing the 65 and over ones according to socio-demographic, clinical, geographic and trajectory criteria.
RESULTS
RESULTS
This population represents 9.7% of all first consulting in CMHCs. We can note that 70.5% are female, 46.8% are living alone and 31.2% are widowed. These 3 rates are higher than in the general population. The main diagnosis we found is mood disorder (35.1%). Organic mental disorders are scarce (8.2%). Most people are referred by a general practitioner (53.4%) or a specialist/hospital center (23.7%). The main referral at the end is to CMHC care (73.6%). Only 20.0% had a referral to non-psychiatric health professionals (GP, coordination support teams, geriatrics, other professionals). Significant differences in the referral at the end exist between 65 and 74, who are more referred to CMHC professionals, and 75 and over, who are more frequently referred to non-psychiatric health professionals. Significant discrepancies about who referred are found according to community area-type.
CONCLUSION
CONCLUSIONS
These results align with the literature about known health-related characteristics and the importance of depression in the older people. They question the link with non-psychiatric professionals, and the need to structure a homogeneous care organization in psychiatric care for the older adults with trained professionals, especially for the 75 and over.
Identifiants
pubmed: 39385169
doi: 10.1186/s12913-024-11680-y
pii: 10.1186/s12913-024-11680-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1208Informations de copyright
© 2024. The Author(s).
Références
Coldefy M, Gandré C. Institut De Recherche Et documentation en économie de la santé (France), Agence De La biomédecine (France). Atlas de la santé mentale en France. Paris: IRDES; 2020.
Jovelet G. La Psychiatrie de la personne âgée, une identité en questions. Perspect Psy. 2020;59(1):53–63.
doi: 10.1051/ppsy/202059053
WHO. 1996. WHO Psychiatry of the elderly. WHO; 1996. Available from: https://www.who.int/mental_health/media/en/17.pdf . [cited 2020 Oct 20].
WHO. OMS résumé rapport mondial sur le vieillisement et la santé. WHO; 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/186469/WHO_FWC_ALC_15.01_fre.pdf;jsessionid=58AB58C582A76CB30AFF921D71E9C0C?sequence=1 . [cited 2020 Oct 20].
Volkert J, Schulz H, Härter M, Wlodarczyk O, Andreas S. The prevalence of mental disorders in older people in western countries – a meta-analysis. Ageing Res Rev. 2013;12(1):339–53.
doi: 10.1016/j.arr.2012.09.004
pubmed: 23000171
Andreas S, Schulz H, Volkert J, Dehoust M, Sehner S, Suling A, et al. Prevalence of mental disorders in elderly people: the European MentDis_ICF65 + study. Br J Psychiatry. 2017;210(2):125–31.
doi: 10.1192/bjp.bp.115.180463
pubmed: 27609811
Byers AL, Yaffe K, Covinsky KE, Friedman MB, Bruce ML. High occurrence of Mood and anxiety disorders among older adults: the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2010;67(5):489–96.
doi: 10.1001/archgenpsychiatry.2010.35
pubmed: 20439830
pmcid: 2933177
Investigators TEsem 2000, Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS et al. Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand. 2004;109(s420):47–54.
Ritchie K, Artero S, Beluche I, Ancelin ML, Mann A, Dupuy AM, et al. Prevalence of DSM-IV psychiatric disorder in the French elderly population. Br J Psychiatry. 2004;184(2):147–52.
doi: 10.1192/bjp.184.2.147
pubmed: 14754827
Observatoire national du suicide (France). Suicide: état des lieux des connaissances et perspective de recherche. Paris: Observatoire national du suicide (ONS); 2014.
Irigoyen-Otiñano M, Puigdevall-Ruestes M, Mur-Laín M, González-Pinto A, Portella MJ, Baca-García E, et al. Absence of association between the level of lethality and the recidivism of suicide attempts in a Spanish province. Actas Esp Psiquiatr. 2019;47(5):179–89.
pubmed: 31648340
Mouquet MC, Bellamy V. Suicides et tentatives de suicide en France. DREES. 2006(488):8.
Bilan démographique 2019. en Bretagne: légère baisse des naissances et des décès - Insee Analyses Bretagne – 96. Available from: https://www.insee.fr/fr/statistiques/4776248 . [cited 2022 Jun 29].
Observatoire national du suicide (France). Suicide: connaître pour prévenir. Dimensions nationales, locales et associatives – 2e rapport / février 2016 | Direction de la recherche, des études, de l’évaluation et des statistiques. 2016. Available from: https://drees-site-v2.cegedim.cloud/publications-documents-de-reference/rapports/suicide-connaitre-pour-prevenir-dimensions-nationales . [cited 2021 May 11].
Or Z, Gandré C, Seppänen AV, Hernández-Quevedo C, Webb E, Michel M, Chevreul K, France. Health System Summary 2024. Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies; 2023. Available from: https://iris.who.int/bitstream/handle/10665/376804/9789289059572-eng.pdf?sequence=1 . [cited 2024 Sep 3].
Dupays S, Emmanuelli DJ. Les centres médico-psychologiques de psychiatrie générale et leur place dans le parcours du patient. IGAS; 2020. p. 132. Report 2019-090R.
PTSM35. Ministère des Solidarités et de la Santé. 2018. dtsm_35.pdf. Available from: https://solidarites-sante.gouv.fr/IMG/pdf/dtsm_35.pdf . [cited 2020 Oct 13].
Pancrazi MP, Guinard P, Isserlis C. L’organisation de la psychiatrie du sujet âgé en Île-de-France. Inf Psychiatr. 2015;91(9):755–61.
Cohen L, Desmidt T, Limosin F. La Psychiatrie De La Personne âgée: Enjeux et perspectives. Ann Méd-Psychol Rev Psychiatr. 2014;172(9):781–4.
Schwarz T, Schmidt AE, Bobek J, Ladurner J. Barriers to accessing health care for people with chronic conditions: a qualitative interview study. BMC Health Serv Res. 2022;22:1037.
doi: 10.1186/s12913-022-08426-z
pubmed: 35964086
pmcid: 9375930
WHO. Brochure: Soins intégrés pour les personnes âgées (SIPA) Directives applicables aux interventions communautaires liées au déclin des capacités intrinsèques. Available from: https://www.who.int/fr/publications/i/item/WHO-MCA-17.06.10 . [cited 2024 Aug 5].
WHO. Mental health of older adults. WHO; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults . [cited 2024 Aug 5].
Draper B. What is the effectiveness of old-age mental health services? J Health Serv Res Policy. 2007;12(2):127–127.
doi: 10.1258/135581907780279602
Bajeux E, Corvol A, Somme D. Integrated Care for older people in France in 2020: findings, challenges, and prospects. Int J Integr Care 21(4):16.
WHO. Integrating the response to mental disorders and other chronic diseases in health care systems. Geneva: World Health Organization. 2014. Available from: https://apps.who.int/iris/handle/10665/112830 . [cited 2023 Jul 10].
Aurore H. Réponse à la saisine du 30 octobre 2014 en application de l’article L.161 – 39 du code de la sécurité sociale Repérage et évaluation des facteurs de risque de dépression chez les séniors de 55 ans et plus. 2014. p. 44.
Léon C, Beck F. Les comportements de santé des 55–85 ans. Analyses du Baromètre santé 2010.. Saint-Denis: Inpes; 2014. p. 192 (Baromètre Santé). Available from: https://www.santepubliquefrance.fr/docs/les-comportements-de-sante-des-55-85-ans.-analyses-du-barometre-sante-2010 .
Lépine JP, Gasquet I, Kovess V, Arbabzadeh-Bouchez S, Nègre-Pagès L, Nachbaur G, et al. Prevalence and comorbidity of psychiatric disorders in the French general population. L’Encephale. 2005;31(2):182–94.
doi: 10.1016/S0013-7006(05)82385-1
pubmed: 15959445
UMR 1041 CESAER (Inra / AgroSup Dijon), UMR 6049 ThéMA (Université de Franche-Comté / CNRS), UR DTM (Cemagref), UMR 1273 METAFORT (AgroParisTech / Cemagref / Inra / VetAgroSup). Délégation interministérielle à l’aménagement du territoire et l’attractivité régionale, Ministère de l’agriculture, de l’alimentation, de la pêche, de la ruralité et del ’aménagement du territoire. Typologie des campagnes françaises et des espaces à enjeux spécifiques (littoral et montagne). 2011;3:336.
HAS. eval_interventions_ameliorer_pratiques_guide.pdf. 2007. Available from: https://www.has-sante.fr/upload/docs/application/pdf/eval_interventions_ameliorer_pratiques_guide.pdf . [cited 2022 Sep 12].
INSEE. INSEE. 2020. POP3 - Population de 15 ans ou plus par sexe, âge et statut conjugal en 2017 – Département d’Ille-et-Vilaine (35) –Évolution et structure de la population en 2017 | Insee. Available from: https://www.insee.fr/fr/statistiques/4515323?sommaire=4515349&geo=DEP-35 . [cited 2021 Mar 18]
Kovess-Masfety V, Alonso J, Brugha TS, Angermeyer MC, Haro JM, Sevilla-Dedieu C. Differences in lifetime use of services for mental health problems in six European countries. Psychiatr Serv. 2007;58(2):213–20.
doi: 10.1176/ps.2007.58.2.213
pubmed: 17287378
Milleret G, Benradia I, Guicherd W, Roelandt JL. États Des Lieux. Recherche action nationale « place de la santé mentale en médecine générale ». Inf Psychiatr. 2014;90(5):311–7.
Labarthe G. Les consultations et visites des médecins généralistes - Un essai de typologie. DREES. 2004(315):12.
Dumesnil H, Cortaredona S, Cavillon M, Mikol F, Aubry C, Sebbah R, et al. Prise en charge de la dépression en médecine générale de ville. Inf Psychiatr. 2014;90(5):341–52.
INSEE. INSEE. 2021. Dossier complet – Département d’Ille-et-Vilaine (35) | Insee. Available from: https://www.insee.fr/fr/statistiques/2011101?geo=DEP-35#chiffre-cle-2 . [cited 2021 Mar 18].
Galinowski A. L’annonce Du diagnostic en psychiatrie. Laennec. 2011;59(3):44–58.
doi: 10.3917/lae.113.0044
Paccaloni M, Moretti F, Zimmermann C. Giving information and involving in treatment: what do psychiatrists think? A review. Epidemiol Psychiatr Sci. 2005;14(4):198–216.
doi: 10.1017/S1121189X00007958
Mitchell AJ. Reluctance to disclose difficult diagnoses: a narrative review comparing communication by psychiatrists and oncologists. Support Care Cancer. 2007;15(7):819–28.
doi: 10.1007/s00520-007-0226-y
pubmed: 17333297
Irigoyen M, Porras-Segovia A, Galván L, Puigdevall M, Giner L, De Leon S, et al. Predictors of re-attempt in a cohort of suicide attempters: a survival analysis. J Affect Disord. 2019;247:20–8.
doi: 10.1016/j.jad.2018.12.050
pubmed: 30640026
Woolley JD, Khan BK, Murthy NK, Miller BL, Rankin KP. The diagnostic challenge of psychiatric symptoms in neurodegenerative disease; rates of and risk factors for prior psychiatric diagnosis in patients with early neurodegenerative disease. J Clin Psychiatry. 2011;72(2):126–33.
doi: 10.4088/JCP.10m06382oli
pubmed: 21382304
pmcid: 3076589
Ismail Z, Smith EE, Geda Y, Sultzer D, Brodaty H, Smith G, et al. Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimers Dement. 2016;12(2):195–202.
doi: 10.1016/j.jalz.2015.05.017
pubmed: 26096665
Assemblée N. Assemblée nationale. Rapport d’information déposé en application de l’article 145 du règlement, par la commission des affaires sociales, en conclusion des travaux d’une mission d’information relative à l’organisation de la santé mentale (Mme Caroline Fiat et Mme Martine Wonner). 2019. Available from: https://www.assemblee-nationale.fr/dyn/15/rapports/cion-soc/l15b2249_rapport-information . [cited 2021 May 11].
Clément JP. Psychiatrie De La Personne âgée. 1ère. Paris: Flammarion-Lavoisier; 2010. p. 649.
Barlet M, Coldefy M, Collin C, Lucas-Gabrielli V. L’Accessibilité Potentielle localisée (APL): une nouvelle mesure de l’accessibilité aux soins appliquée aux médecins généralistes libéraux en France. DREES. 2012(124):59.
Ben Thabet J, Ammar Y, Charfi N, Zouari L, Zouari N, Gaha L, et al. Critical study of the treatment of 159 elderly in psychiatric consultation. Pan Afr Med J. 2014;17:160.
pubmed: 25120873
pmcid: 4119448
Abdul-Hamid WK, Lewis-Cole K, Holloway F, Silverman AM. Comparision of how old age psychiatry and general adult psychiatry services meet the needs of elderly people with functional mental illness: cross-sectional survey. Br J Psychiatry. 2015;207(5):440–3.
doi: 10.1192/bjp.bp.114.145706
pubmed: 26450580
Department of Health. National_Service_Framework_for_Older_People.pdf. 2001. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/198033/National_Service_Framework_for_Older_People.pdf . [cited 2022 Sep 21].
Tucker S, Baldwin R, Hughes J, Benbow S, Barker A, Burns A, et al. Old age mental health services in England: implementing the National Service Framework for older people. Int J Geriatr Psychiatry. 2007;22(3):211–7.
doi: 10.1002/gps.1662
pubmed: 16988950
Verbeek H, Worden A, Wilberforce M, Brand C, Tucker S, Abendstern M, et al. Community mental health teams for older people in England: variations in ways of working. Int J Geriatr Psychiatry. 2018;33(3):475–81.
doi: 10.1002/gps.4775
pubmed: 28833581
Klug G, Gallunder M, Hermann G, Singer M, Schulter G. Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies. BMC Psychiatry. 2019;19:382.
doi: 10.1186/s12888-019-2369-z
pubmed: 31796012
pmcid: 6889722
Houbin B. Missions et organisation des équipes mobiles de psychiatrie du sujet âgé: exemple de l’équipe mobile de psychiatrie de la personne âgée ouest 94 (EMPPA Ouest 94) du groupe hospitalier Paul-Guiraud. NPG Neurol Psychiatr Gériatr. 2015;15(89):266–9.
doi: 10.1016/j.npg.2015.03.002
Thiebaux JF, Kardache F. Le Dispositif ESSPER De gérontopsychiatrie Et son unité de rattachement Germaine-Le-Guillant. Inf Psychiatr. 2014;90(7):539–50.
https://www.legifrance.gouv.fr /. Arrêté du 21 avril 2017 relatif aux connaissances, aux compétences et aux maquettes de formation des diplômes d’études spécialisées et fixant la liste de ces diplômes et des options et formations spécialisées transversales du troisième cycle des études de médecine - Légifrance. Available from: https://www.legifrance.gouv.fr/loda/id/LEGISCTA000034508231 . [cited 2024 Sep 3].
LOI n°. 2016-41 du 26 janvier 2016 de modernisation de notre système de santé (1). 2016-41 Jan 26, 2016.
LOI n° 2019 – 774 du 24. juillet 2019 relative à l’organisation et à la transformation du système de santé (1) - Légifrance. [cited 2024 Sep 9]. Available from: https://www.legifrance.gouv.fr/jorf/id/JORFARTI000038821303 .