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

This thesis includes four studies on prevalence and implications of geriatric syndromes and multimorbidity (chronic health conditions) in older patients with different psychiatric disorders and in different settings.

Two studies on medically unexplained symptoms (MUS) found that these symptoms are 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.

Persons aged 80 and over, have little benefit from antidepressants when treated for a depressive disorder. Whether this is due to frailty, multimorbidity, undernutrition, functional impairment or cognitive dysfunction remains unclear, because the conducted systematic review showed that these characteristics were barely taken into account in treatment studies on depression in older adults and that persons aged 75 years and over, were underrepresented. This means that the results of these studies are not applicable to many of the patients whom doctors actually have to treat.

The last study found that 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 are relevant and have implications for 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.

Carolien Benraad defended her thesis on 12 February 2021.