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Detecting psychogeriatric problems in primary care: factors related to psychiatric symptoms in older community patients

Objective : The aim was to determine the relationship and influence of different variables on the psychiatric symptomatology of older people who reside in the community, as detected by family practitioners. Design : A cross-sectional and multi-centre study. Setting Twenty-eight general practices and two psychiatric practices in Huesca, Spain, from 19 primary care health centres. Subjects  :A sample of 324 patients aged over 65 years, representative of the older people who reside in the community in the province of Huesca. Main outcome measures Symptoms of depression (YesavageGDS),cognitive impairment (MMSE), anxiety (GADS), psychotic symptoms, obsessive symptoms and hypochondriacal ideas (GMS) were measured by family practitioner and were detected following specific questions from the Geriatric Mental State (GMS-B) examination, following DSM-IV criteria, being defined as ‘concern and fear of suffering, or the idea of having a serious disease based on the  interpretation of somatic symptoms’. Sociodemographic, physical and somatic, functional and social data were evaluated. Analysis was carried out in three phases: univariate, bivariate and multivariate with logistic regression Results:  At the time of the study, 46.1% of the older people studied suffered from some psychiatric symptom; 16.4% had cognitive impairment, 15.7% anxiety, 14.3% depression, 6.1% hallucinations and delusions, 7.2% hypochondriacal ideas and 4.4% obsessive symptoms. Female gender was significantly associated with depression (prevalence ration (PR) 3.3) and anxiety (PR 3.9). Age was a factor associated with cognitive impairment (PR 4.4). Depression was significantly related  to severity of the physical illness (PR 61.7 in extremely severe impairment). Isolation (PR 16.3) and being single (PR 13.4) were factors which were strongly associated with anxiety; living in a nursing home was associated with psychotic symptoms (PR 7.6). Conclusions :  Severity of physical illness, isolation, living in a nursing home and female gender, among others, are related to psychiatric symptoms in community-residing older people identified in primary healthcare centres.

Author(s): Javier Olivera, Sergio Benabarre, Teo´ filo Lorente, Mariano Rodriguez, Alfonso Barros, Carmen Quintana, Virtudes Pelegrina, Carmen Aldea

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