Characteristics and Satisfaction with Services of Patients Attending A Geriatric Psychiatry Clinic in Southern India

Characteristics and Satisfaction with Services of Patients Attending A Geriatric Psychiatry Clinic in Southern India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Characteristics and Satisfaction with Services of Patients Attending A Geriatric Psychiatry Clinic in Southern India Sheeba Ninan, Fathima Hanan Kilikkotte, Aswin Kollamkandipalliyali, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5890068/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Specialist services like geriatric psychiatric clinics aim to provide a multidisciplinary and person-centred approach. There is not enough information available about the number and type of such clinics in India. In this descriptive paper, we aim to detail the services provided and the sociodemographic and clinical characteristics of patients who have attended the geriatric psychiatry outpatient clinic at the Institute of Mental Health and Neurosciences, Kerala, in Southern India. A specific data sheet was used to transfer the sociodemographic and clinical details of patients who attended the weekly Geriatric Psychiatry Outpatient clinic. The clinic uses a comprehensive proforma and assessment tool as appropriate. The Short Assessment of Patient Satisfaction Scale was used to assess the satisfaction with the services. Between August 2023 and March 2024, eighty patients attended the Geriatric Psychiatry Outpatient Clinic. Men and women were equal in numbers (40, 50%). The mean age of the attendees was 68.91 (sd=6.87). Sixty-four (80%) patients had comorbid medical disorders. The most common psychiatric diagnosis was dementia and adjustment disorder (14; 17.5%). Eight (10%) patients each had depression and anxiety disorders. Regarding treatment, 48 (60%) were prescribed psychotropic medications: 21 were (26.3%) on antipsychotics, 37 (46.3%) were on antidepressants, and 14 (17.5%) were on benzodiazepines. Most of the patients were ‘very satisfied’ with the service, 47 (58.8%) scoring 27 or 28 on SAPS, where the maximum score is 28. The multidisciplinary team in this clinic brings a blend of skills to provide a comprehensive approach to treatment, care, and rehabilitation. Psychiatry Geriatric old age outpatients Dementia Depression Satisfaction India Kerala Introduction A phenomenal increase in the global older adult population to 1.4 billion in 2030 and to 2.1 billion in the next three decades has been predicted by WHO (2024) One of every six people is aged 60 years or over. Developing countries such as India will be home to two-thirds of them. The International Institute for Population Sciences & United Nations Population Fund, in its 2023 India Ageing Report, estimates the decadal growth rate of India's older adults population to be 41%, and this is predicted to double to over 20% of the total population by 2050 in the country. Around 14% of adults aged sixty and over live with a mental disorder (Institute of Health Metrics and Evaluation, 2024), which is often underrecognized and undertreated, and the stigma makes people reluctant to seek help. Psychological and physical disorders frequently coexist among older adults, which increases the disability. Evaluating and addressing the social determinants impacting the mental health of older adults, which include stigma against mental illnesses, mental health care disparity, ageism and social isolation, and loneliness at individual and community levels, is critical for the prevention of mental disorders and enhancement of well-being in the older adults (Reynolds et al., 2022). According to the National Mental Health Survey of India, older adults had a higher weighted lifetime (15.1%) and current (10.9%) prevalence of any psychiatric morbidity, as compared to the younger population (13.4% and 10.5%, respectively) (Sinha et al., 2021 ). With the gradual breakdown of joint families, changing value systems, and urbanization on a background of inadequate older adult's welfare measures initiated by the government, there is an emerging need to pay greater attention to older adult's care and older adults mental health issues (Khandelwal & Pattanayak, 2015 ). There is a huge treatment gap due to several reasons, including poor recognition of the seriousness of the disability it produces. Many countries have addressed this issue by providing specialized services to the elderly population with mental disorders using a multidisciplinary approach. The United Nations declared 2021–2030 as the Decade of Healthy Aging, and the World Health Organization proposes to secure person-centered integrated healthcare and provide access to long-term care as one of the four major target areas. A comprehensive assessment of the older person’s mental health, physical health, social circumstances, medical history, and medications to reach a formulation that spans the biopsychosocial spectrum is often beyond the scope and interest of a generic psychiatric clinic. Multidisciplinary geriatric psychiatry services are best placed to address the following unique challenges. Mental disorders of old age are heterogeneous at multiple levels; etiopathogenesis, clinical presentation, and response to intervention reflect genetic, environmental, social, and developmental vulnerabilities and resilience, emphasizing the need for implementing personalized and effective treatment approaches (Reynolds et al., 2022). A bottom-up approach to geriatric mental health care has been proposed, which includes multidisciplinary care of older adults with dedicated outpatient services to provide integrated care as the need of the hour (Philip et al., 2021 ), and there are guidelines on establishing them in various resource settings (ARDSI, 2024 ). Geriatric psychiatry services provide comprehensive evaluation and diagnosis, medication management, psychotherapy, improved quality of life, and caregiver support. The older adults are distinct from younger individuals physically and psychologically. Cognitive decline related to age associated with brain shrinkage, increased risk of medication side effects, cultural factors impacting the mental health of older adults, social isolation, loss of independence, and changes in family dynamics are some of the factors that make the specialty unique (Morris, 2001 ). In India, specialist services for older adults with mental health issues are few and far between, and when present, we do not have information about how satisfied the service users are (Grover et al., 2021 ). Patient satisfaction with services is an important parameter to evaluate treatment outcomes, and healthcare services are moving towards a client-service provider model in India as well as from practices around the world and as mandated by the WHO under its quality rights initiative for mental health (Jena & Gupta, 2018 ). Measurement of patient ratings of satisfaction with hospital services as a marker of quality in health care and as a tool for improving the quality of medical care has been well-established (Barak et al., 2001 ). Aims and Objectives We aimed to look at the socio-demographic characteristics and clinical profile of the geriatric population accessing the multi-disciplinary led geriatric service in Kerala, explore patient and caregiver satisfaction with the multi-disciplinary geriatric service, and identify areas for improvement. The study evaluated the prevalence of comorbidities among the geriatric population accessing the service. The services provided by a multi-disciplinary team, challenges faced in service delivery, and their final impact on patient outcomes and satisfaction were looked into. Feedback on patient and caregiver experiences with the multidisciplinary approach, focusing on the quality of clinician care, emphasizing communication and joint decision-making, was explored. Based on the study's findings, look for potential areas for improvement and challenges in delivering multi-disciplinary geriatric mental health services. Materials and Methods A specific data sheet was used to transfer the sociodemographic and clinical details of patients who attended the weekly Geriatric Psychiatry Outpatient clinic at the Institute of Mental Health and Neurosciences, Calicut, Kerala, in southern India, from the period August 2023 to March 2024. The multidisciplinary team consists of a geriatric psychiatrist, senior resident, psychiatric social worker, neuropsychologist and clinical psychologist, psychiatric nurse, physiotherapist, speech and language therapist, and special educator. Patients can attend the clinic directly or via referrals from other clinicians or centers. The clinic uses a comprehensive proforma for assessment, including socio-demographic, clinical details, and assessment tools. After registration, patients are initially screened by the psychiatric nursing team with a brief assessment, including a general examination. The geriatric psychiatrist does a comprehensive assessment to make a diagnosis and formulate a care plan. The care plan is based on needs assessment, and referral to respective multi-disciplinary team members is facilitated. Multi-disciplinary team meetings are conducted monthly to discuss new referrals and challenging cases. The inputs from the psychologist include psychological and neuropsychological assessment, psycho-education, cognitive behavior therapy, cognitive retraining, interpersonal therapy, family therapy, stress management, caregiver support, etc. Social worker focuses on assessments and interventions for psychosocial issues, financial support, family therapy, caregiver support, legal support etc. Patients are reviewed every four weeks or earlier as appropriate. All services are offered free of cost. The Short Assessment of Patient Satisfaction (SAPS) scale is commonly used to evaluate patients' contentment with the services they receive. This concise, reliable, and valid seven-item tool effectively measures patient satisfaction regarding their treatment (Hawthorne et al., 2006 ). The scale was carefully designed by selecting items that demonstrate the best measurement properties and provide the most comprehensive coverage of patient satisfaction domains. The SAPS evaluates key areas of satisfaction, such as treatment satisfaction, explanation of treatment results, clinician care, participation in medical decision making, respect by the clinician, time spent with the clinician, and overall satisfaction with hospital/clinic care. The scale employs a 5-point response system and has been validated in clinical environments (Hawthorne et al., 2006 ; Sansoni et al., 2011 ) and is a valid and reliable measure of patient satisfaction. This scale can be applied in any service setting across various treatment groups. The interpretation of the scores is as follows: A score between 0 and 10 reflects significant dissatisfaction, suggesting that the patient feels their healthcare has failed them and they require urgent assistance. A score from 11 to 18 indicates general dissatisfaction, where patients are experiencing shortcomings in multiple aspects of their healthcare and need support in those areas. A score range of 19 to 26 suggests a level of satisfaction, but these patients should be further asked about specific areas of dissatisfaction to guide improvement efforts. Finally, a score of 27 to 28 signals a very high level of satisfaction, indicating that all aspects of care have either met or surpassed the patient's expectations. Microsoft Excel was used for data structuring, and statistical analysis was performed using IBM SPSS version 27. Descriptive statistics of frequency counts and percentages were used for categorical variables. Mean and standard deviation were calculated for continuous variables. Chi-square tests were used to test the difference between two proportions, and paired t-tests were used for continuous data. The difference was considered statistically significant when the p-value was less than 0.05. The study was reviewed and approved by the Ethics Committee of the IMHANS (Institute of Mental Health and Neurosciences), and participant confidentiality was maintained throughout the research. Table 1 Sociodemographic characteristics of clinic attendees Variables Mean (SD)/n (%) Age in years 68.91 (6.87) Median age in years 67 (Range 55 to 86 years) Age group (years) Less than 65 29(36.3) 65 to 74 34 (42.5) 75 to 84 15 (18.8) Above 85 2 (2.5) Gender Male 40 (50) Female 40 (50) Locality Rural 41 (51.2) Urban 39 (48.8) Living situation Alone 4 (5.0) Lives with spouse only 27 (33.75) Lives with family 47 (58.75) Others 2 (2.5) Socio economic status Low 8 (10) Middle 72 (90) Education in years Up to 7 years 44 (55.0) 8 to 14 years 22 (27.6) 15 to 21 years 13 (16.3) Above 21 years 1 (1.3) Mean education in the number of years 9.21 (5.84) RESULTS Between August 2023 and March 2024, eighty patients attended the geriatric psychiatry outpatient clinic. Men and women were equal in numbers (40, 50%). The mean age of the attendees was 68.91 (SD = 6.87), with a range of 55 to 86 years and a median of 67 years. The majority (34; 42.5%) of the patients were in the 65 to 74 age group, followed by 29 (36.3%) who were less than 65 years old. 41 (51.2%) patients were from a rural background, and 72 (90%) belonged to the middle socioeconomic category (72, 90%). Forty-seven (58.75%) attendees lived with their family members, while 27 (33.75%) with just their spouse. The mean education in the number of years of the attendees was 9.21 years (SD = 5.84). 73 (91.3%) were new patients. Most (74; 92.5%) patients attended with a family member. Fifty-four (67.5%) patients had comorbid medical disorders; 25 (31.3%) had multiple diseases. Thirty (37.8%) had hypertension, followed by diabetes (22; 27.5%). Twenty-four (60%) females and 30 (75%) males had physical disorders. There was no statistically significant difference between genders in the presence of a medical diagnosis (p = 0.152). Table 2 Medical and psychiatric diagnoses of clinic attendees Type N (%) Medical Diagnosis Hypertension 30 (37.5) Diabetes 22 (27.5) Hypothyroidism 4 (5.0) DLP 8 (1.0) CAD 7 (8.75) CVA 3 (3.75) Parkinson’s Disease 2 (2.5) Others 10 (12.5) Psychiatric Diagnosis Dementia 14 (17.5) Mild Cognitive Disorder 3 (3.75) Organic Affective disorder 7 (8.75) Psychosis 6 (7.50) Bipolar disorder 2 (2.5) Depression 8 (10) Anxiety Disorder 8 (10) Obsessive Compulsive disorder 3 (3.75) Adjustment disorder 14 (17.5) Somatoform disorder 6 (7.5) Others 9 (11.25) The most common psychiatric diagnosis was dementia and adjustment disorder (14; 17.5%). Eight (10%) patients each had depression and anxiety disorders. Four (28.6%) patients with dementia were less than 65 years old, while 5 (35.7%) belonged to the age group 65 to 74 years. Four (28.6%) of them were in the age category 75 to 84 years, and one (7.1%) patient was above the age of eighty-five. Adjustment disorder (7; 50%) was most common in the age group 65 to 74 years. Depression (4;50%) and anxiety disorders (3; 37.5%) had an equal distribution between those who were less than sixty-five years old and those in the 65 to 74 years age category. Regarding treatment, 48 (60%) were prescribed psychotropic medications: 21 (26.3%) on antipsychotics, 37 (46.3%) on antidepressants, and 14 (17.5%) on benzodiazepines. The most common antipsychotics prescribed were risperidone and olanzapine (8; 38.1%) followed by quetiapine (6; 28.6%). Escitalopram and mirtazapine (13; 35.1%) were the most frequently used antidepressants, followed by fluoxetine and sertraline (4; 10.8%). Clonazepam (13; 92.9%) was the most frequent choice as a sedative-hypnotic. As mood stabilizers, lithium was prescribed for two patients and sodium valproate for one patient. Among 14 patients who had dementia, 11 (78.6%) patients were on medications for dementia. Among medications for dementia, donepezil was prescribed for five (45.5%) patients, memantine for three, and a combination of them also for three (27.3%) patients. 4 (28.6%) were on antipsychotics for behavioral and psychological symptoms, which were severe and non-responsive to psychosocial interventions. Table 3 Details of medications prescribed to the clinic attendees Prescriptions N (%) Antipsychotics (n = 21) Amisulpiride 1 (4.8) Aripiprazole 1 (4.8) Clozapine 1 (4.8) Olanzapine 8 (38.1) Quetiapine 6 (28.6) Risperidone 8 (38.1) Antidepressants (n = 37) Desvenlafaxine 1 (2.7) Escitalopram 13 (35.1) Fluoxetine 4 (10.8) Mirtazapine 13 (35.1) Sertraline 4 (10.8) Trazadone 3 (8.1) Venlafaxine 1 (2.7) Dementia medications (n = 11) Donepezil only 5 (45.5) Memantine only 3 (27.3) Donepezil and Memantine 3 (27.3) Benzodiazepenes (n = 14) Clonazepam 13 (92.9) Diazepam 1 1 (7.1) Thirty-eight (47.5%) patients were referred for inputs by psychiatric social workers who were trained for various therapeutic interventions, which included supportive therapy, family therapy, and geriatric wellbeing groups. Twenty–two (27.5%) patients for clinical psychology inputs, including assessments, cognitive behavior therapy, etc. Three (3.8%) declined psychosocial interventions. Two (2.5%) patients received interventions from other professionals like physiotherapy. Follow-ups are arranged between one week and 8 weeks. Most are scheduled for a visit after 4 weeks (26, 32.5%), followed by 6 weeks for 17 (21.3%) patients. Most patients were ‘very satisfied’ with the service, 47 (58.8%) scoring 27 or 28 on SAPS, where the maximum score is 28. Twenty-eight patients (35.0%) were ‘satisfied’ with the service, scoring between 19 and 26. One patient was dissatisfied with the service. The mean score was 26.01 (SD = 2.77). There was no statistically significant difference (p = 0.390; df = 74) in the total satisfaction score between men (26.32, SD = 2.73) and women (25.72, SD = 2.81). There was no statistically significant relationship between education in a number of years and total satisfaction score (p = 0.558). Table 4 Scores of Short Assessment of Patient Satisfaction scale items SAPS Items Mean score SD How satisfied are you with the effect of your {treatment/care} 3.39 0.83 How satisfied are you with the explanations the {doctor/other health professional} has given you about the results of your {treatment/care}? 3.88 0.36 The {doctor/other health professional} was very careful to check everything when examining you. 3.77 0.48 How satisfied were you with the choices you had in decisions affecting your health care? 3.84 0.4 How much of the time did you feel respected by the {doctor/other health professional}? 3.95 0.22 The time you had with the {doctor/other health professional} was too short. 3.58 0.69 Are you satisfied with the care you received in the {hospital/clinic}? 3.53 0.75 Total Score 26.01 2.77 DISCUSSION After the Second World War, a rapidly aging society led to end the increased prevalence of dementia. This led to geriatric psychiatry as a distinct professional entity in the latter part of the 20th century across North America and Europe (Ballenger, 2022 ). Grover et al. ( 2021 ) report a lack of geriatric mental health services and minimal attention to geriatric psychiatry as a subspeciality during training. The need for geriatric psychiatric clinics was recognized early on (Ghosh, 2006) as the presentation of psychiatric illnesses among the elderly differs from that of adult patients. Additionally, physical illness often presents with psychological symptoms and vice versa. Along with the natural ageing of the brain, various factors contribute to psychological issues among the older adults in India. These include physical health problems, cerebral pathology, and socio-economic challenges such as the disintegration of family support systems, social isolation, and reduced financial independence. These factors have been recognized as significant contributors to the burden of mental disorder morbidities faced by older adults in India (Guha, 1994 ). In addition to the unique needs geriatric populations have, there are a wide variety of challenges seen at different levels of care and treatment, from acceptance, help-seeking, and compliance (Lodha & De Sousa, 2018 ). The multidisciplinary team in this clinic brings a blend of experience and skills to provide a comprehensive approach to treatment, care, and rehabilitation with a focus on recovery goals. A multidisciplinary team includes psychiatrists, psychologists, social workers, psychiatric nurses, occupational therapists, and other allied health professionals who as a team can conduct comprehensive assessments that include medical, psychological, psychosocial, and environmental factors and provide accurate diagnoses and tailored treatment plans. Each member of the multidisciplinary team, being experts in their area, can bring unique expertise and skills to the individual case. Clear delineation of the role of each member of the multidisciplinary team makes it effective. There is concidarable variability in how older adults respond to medications as well as psychosocial and psychotheraptic interventions, higliting the importance of personalized medicine. In this clinic, a patient-centered approach is utilized with a collaborative decision-making process among team members where treatment plans are tailored to the individual's preferences as appropriate. The multidisciplinary team also focuses on preventive strategies, early intervention, identifying risk factors, detecting problems at an early stage, and formulating risk management strategies, thus improving prognosis and treatment outcomes. Geriatric mental health issues often require long-term management and support, and a multidisciplinary team can provide continuity of care that is comprehensive and holistic. Encouraging healthy brain aging and cognitive fitness in the later years of life is also crucial. (Reynolds et al., 2022). The prevalence of mental disorders among the older adults varies depending on the setting, and tools used and the prevalence among this clinic sample is comparable to the reported rates (Pilania et al., 2019 ; Rajkumar et al., 2023 ; Tiwari & Pandey, 2012 ). The medication prescriptions adhere to the national guidelines (Avasthi & Grover, 2018 ; Gautam et al., 2017 ; Shaji et al., 2018 )The clinic adopts the policy of following well-recognized guidelines in prescribing medications that are only necessary at appropriate doses, closely monitoring the side effects, and conducting periodic reviews. Clinicians working in geriatric psychiatry clinics benefit from having a substantial interest and skills in understanding coexisting physical disorders. Older adults experience a higher prelevence of multiple conditions such as diabetes, lung disease, and cardiovascular disase, older adults with mental health disorders and other co morbidities which are liked to early mortality, disability, and impered functioning (Adamis & Ball, 2000 ; Bartels, 2011 ). Specialized clinical settings can optimize the safety and efficacy of pharmacotherapy and pay specific attention to metabolic, cardiovascular, and neurological tolerability. (Reynolds et al., 2022) older adults face greater physical health burden, comorbidities, and premature mortality. Those with chronic and severe mental health issues are at risk, as situation often exacerbated by agisam in health care which is manifested by a lack of enthusiasm for diagnosis and treatment, as well as therapeutic nihilism.(WPA, 2023 ). A wide variety of psychosocial interventions are provided in this clinic. Evidence-based psychosocial interventions (Samhsa, 2021 ) ), such as skills training programs, assist individuals in acquiring behavioral strategies to better manage their condition, develop independent living abilities, and enhance social interactions. Psychotherapy plays a key role in supporting individuals with mental health conditions by enhancing their daily functioning, well-being, and overall quality of life. Illness self-management approaches aim to strengthen an individual’s capacity to handle both physical and mental health challenges, fostering an active role in their recovery process. Additionally, interventions designed for families or caregivers focus on addressing their specific mental health needs and concerns, providing support to those who care for individuals with mental health conditions. Geriatric clinics should have access to recommended (WHO, 2016) Psychosocial interventions include psychoeducation, psychological treatments, and interventions to reduce stress, strengthen social support, and promote functioning in daily activities. In addition to the provision of recommended psychosocial interventions in this clinic, geriatric well-being groups are conducted on a weekly basis on an open basis, which lasts for around two hours, where psychoeducation, supportive interventions, cognitive stimulation activities, etc are included. Patients attend three to four sessions and are welcome if they want to come back for more sessions. The majority (74; 92.5%) of patients attended the clinic with their family members, who are also informal caregivers, and the clinic focuses on their needs as well. Caregiver burden can be reduced by information and support. Caregivers of older individuals with mental disorders often experience significant burden and require both information and support. Involving them as informal members of the caregiving team offers mutual benefits for both the patient and the caregivers, while also enabling more accurate clinical assessments and targeted interventions to promote well-being and prevent serious negative outcomes. This highlights the importance of providing care that is not solely focused on the patient but also incorporates a family-centered approach (Reynolds et al., 2022). The concept of obligation and respect towards elders form the cornerstone for informal care which is a natural resource that is on the decline due to factors including the nuclearization of families, which necessitates facilitating formal systems of care for the older adult population (Shaji, 2015 ). Multidisciplinary geriatric psychiatry clinics are in a position to support families in optimizing the mental health of older adults and working towards a recovery goal. The overall level of satisfaction among attendees here was higher than that reported by other outpatient services (Bandhu et al., 2023 ). Satisfaction is linked to whether patients perceive the services provided as adequate and in line with their expectations. However, the exact process by which patients form satisfaction or dissatisfaction remains unclear, as satisfaction is generally thought to reflect how well their expectations of treatment have been met or surpassed. These expectations are largely shaped by the interpersonal aspects of care (Harris et al., 2024 ). The clinic attendees suggested improving existing infrastructure for ease of access and more facilities for pharmacology and investigation. Multiple forms of discrimination and stigma, including ageism (discrimination based on age) and mentalism (discrimination against individuals with mental disorders) (Peisah et al., 2022 ; WHO, 2002), as well as structural ageism—age-based discrimination embedded in institutional policies, practices, behaviors, and procedures can be partially addressed through services like geriatric psychiatric clinics. Tackling the social determinants of health within an integrated healthcare approach is crucial for improving health outcomes and reducing existing disparities in the health of older adults (Perez et al., 2022) ). Social workers play a significant role in advancing these efforts. A specialist service like a geriatric psychiatry clinic will be able to incorporate a cultural formulation, which newer diagnostic systems focus on. Cultural formulation acknowledges certain cultural themes that have special reference to the elderly (Sakauye, 2015 ) and emphasizes the subjective expressions of the perception of the illness and its causes, their ideas about what would be helpful, and their level of comfort by the ideas put forward by the treating team. The lack of emphasis on the healthcare needs of older adults appears to contribute to the low level of public awareness regarding mental health issues in later life (Sathyanarayana Rao & Shaji, 2007 ). ). For a long time, older adults were viewed merely as an extension of the adult population, which resulted in limited research specifically focused on this age group in India. Consequently, healthcare services tailored to their needs were not prioritized. However, with a growing understanding that older adults are distinct psychologically, biologically, and socially, there has been a gradual shift in how they are approached (Tiwari & Pandey, 2012 ). The challenges of limited awareness, inadequate training opportunities, unequal distribution of healthcare resources, and the near absence of chronic care models in geriatric psychiatry in India have led to increased efforts in raising awareness, building capacity, and strengthening training and research activities (Prakash & Kukreti, 2013 ). Recommendations for future-proofing geriatric mental health services in India include urgently strengthening healthcare delivery systems through a comprehensive, multipronged approach, focusing on developing a well-trained workforce and improving infrastructure. It is also crucial to implement review mechanisms to ensure updates on best practices and evidence-based medicine, with periodic evaluations(Philip et al., 2021 ) In this context, specialized old-age mental health services are well-positioned to drive these efforts forward, offering both care and necessary training and clinical exposure for undergraduates and postgraduates. Collaborative care models between geriatric medicine specialists and psychiatrists can help deliver this model without placing additional strain on existing resources (Philip et al., 2021 ). Conclusions Considering the high prevalence and morbidity associated with mental disorders among older adults and the high level of satisfaction among those who use services specifically for them, there is an urgent need to establish more geriatric psychiatry clinics across India. The multidisciplinary approach will help in addressing the specific issues of this population, which may often be time-consuming and require the involvement of various professionals without having to compete with the younger population. There is a need to have quality indicators to evaluate the systems and processes involved in such specialist clinics to ensure the satisfaction of service users. They should be culturally sensitive and capable of offering appropriate comprehensive care and support. 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Springer India. https://doi.org/10.1007/978-81-322-1674-2_25 Lodha, P., & De Sousa, A. (2018). Geriatric mental health: The challenges for India. Journal of Geriatric Mental Health, 5 (1), 16-29. https://doi.org/10.4103/jgmh.jgmh_34_17 Morris, D. L. (2001, 2001/12/01/). Geriatric mental health: An overview. Journal of the American Psychiatric Nurses Association, 7 (6), S2-S7. https://doi.org/10.1067/mpn.2001.120851 Peisah, C., de Mendonça Lima, C., Verbeek, H., & Rabheru, K. (2022, Nov). IPA and WPA-SOAP joint statement on the rights of older persons with mental health conditions and psychosocial disabilities. Int Psychogeriatr, 34 (11), 943-947. https://doi.org/10.1017/s1041610221000454 Philip, S., Gajera, G., Nirisha, P. L., Sivakumar, P. T., Barikar, M. C., Panday, P., Patley, R., Chander, R., Sinha, P., Basavarajappa, C., Manjunatha, N., Kumar, C. N., & Math, S. B. (2021). Future-Proofing Geriatric Mental Health Care Services in India: Training and Policy Directions. Indian Journal of Psychological Medicine, 43 (5_suppl), S134-S141. https://doi.org/10.1177/02537176211032342 Pilania, M., Yadav, V., Bairwa, M., Behera, P., Gupta, S. D., Khurana, H., Mohan, V., Baniya, G., & Poongothai, S. (2019, 2019/06/27). Prevalence of depression among the elderly (60 years and above) population in India, 1997–2016: a systematic review and meta-analysis. BMC Public Health, 19 (1), 832. https://doi.org/10.1186/s12889-019-7136-z Prakash, O., & Kukreti, P. (2013, 2013/03/01). State of Geriatric Mental Health in India. Current Translational Geriatrics and Experimental Gerontology Reports, 2 (1), 1-6. https://doi.org/10.1007/s13670-012-0034-1 Rajkumar, J. L., Viggeswarapu, S., Kurian, S., Nandyal, M. B., & Gowri, M. (2023). Addressing the mental health needs of India’s aging population: Understanding depression prevalence and social risk factors in tertiary care outpatients. Indian Journal of Psychiatry, 65 (9), 949-954. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_352_23 Reynolds, C. F., 3rd, Jeste, D. V., Sachdev, P. S., & Blazer, D. G. (2022, Oct). Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry, 21 (3), 336-363. https://doi.org/10.1002/wps.20996 Sakauye, K. (2015, 2015/07//). Diversity and cultural competence: Part 2: cultural issues in treating geriatric patients with mental illness. Psychiatric Times , 32 (7), 16. https://link.gale.com/apps/doc/A422625490/HRCA?u=anon~6d7cac2f&sid=googleScholar&xid=a31f6cf5 Samhsa, S. A. a. M. H. S. A. (2021). Psychosocial Interventions for Older Adults With Serious Mental Illness . Retrieved 11 November 2024 from https://store.samhsa.gov/product/psychosocial-interventions-older-adults-serious-mental-illness/pep21-06-05-001 Sansoni, J., Hawthorne, G., Fleming, G., Owen, E., & Marosszeky, N. (2011). Technical manual and instructions: Revised incontinence and patient satisfaction tools. New South Wales, Australia: Centre for Health Service Development, University of Wollongong, 25 (21), 12-24. Sathyanarayana Rao, T. S., & Shaji, K. S. (2007). Demographic aging: Implications for mental health. Indian Journal of Psychiatry, 49 (2), 78-80. https://doi.org/10.4103/0019-5545.33251 Shaji, K. (2015). Cultural and social aspects of mental illness among the elderly. World Cultural Psychiatr Res Rev , 51-54. Shaji, K. S., Sivakumar, P. T., Rao, G. P., & Paul, N. (2018). Clinical Practice Guidelines for Management of Dementia. Indian Journal of Psychiatry, 60 (Suppl 3), S312-S328. https://doi.org/10.4103/0019-5545.224472 Sinha, P., Hussain, T., Boora, N. K., Rao, G. N., Varghese, M., Gururaj, G., & Benegal, V. (2021, 2021/01/01/). Prevalence of Common mental disorders in older adults: Results from the National Mental Health Survey of India. Asian Journal of Psychiatry, 55 , 102463. https://doi.org/10.1016/j.ajp.2020.102463 Tiwari, S. C., & Pandey, N. M. (2012). Status and requirements of geriatric mental health services in India: An evidence-based commentary. Indian Journal of Psychiatry, 54 (1), 8-14. https://doi.org/10.4103/0019-5545.94639 WHO, W. H. O. (2002). Reducing stigma and discrimination against older people with mental disorders . Retrieved 13 November 2024 from https://www.who.int/publications/i/item/WHO-MSD-MBD-02.3 WHO, w. h. O. (2016). mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (‎mhGAP)‎, version 2.0 . Retrieved 12 November 2024 from https://www.who.int/europe/publications/i/item/9789241549790 WHO, W. H. O. (2024). Ageing . World Health Organization (WHO). Retrieved 10 August 2024 from https://www.who.int/health-topics/ageing#tab=tab_1 WPA, w. P. A. (2023). Newsletter of the Section of Old Age Psychiatry . Retrieved 12 August 2024 from https://www.wpanet.org/ec-news Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5890068","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":406281024,"identity":"0a0772df-f524-463b-bb0d-a06b39c49cdd","order_by":0,"name":"Sheeba Ninan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYDACCQYGZgiLh/EBiOQjRQuzAYhkI0ULmwSIIqhFfnbzwccFNXfsDY6fPVb5NcdOho2B+eGjG3i0GNw5lmw849izxA1n8tJuy25LBjqMzdg4B58WiRwzaR62wwkGN3jMbktuYwZq4WGTxqdFfkb+9988/w7bg7QUS26rJ6yF4UYOGzNv22HGDUAtjB+3HSasxeBGmrH0zL5niTPP5BhLM247zsPGTMAv8jOSH34u+HbHnu/4GcOPP7dV2/OzNz98jNdhEHCAQeEAMIJ4QGxmwsohWuQbGBgYfxCnehSMglEwCkYYAAB/eEjYJxSMnAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0007-0071-3077","institution":"Institute of Mental Health and Neurosciences","correspondingAuthor":true,"prefix":"","firstName":"Sheeba","middleName":"","lastName":"Ninan","suffix":""},{"id":406281025,"identity":"b2f9b60e-6131-42a7-b859-9a8dcc6baea3","order_by":1,"name":"Fathima Hanan Kilikkotte","email":"","orcid":"https://orcid.org/0009-0002-9091-3913","institution":"Institute of Mental Health and Neurosciences","correspondingAuthor":false,"prefix":"","firstName":"Fathima","middleName":"Hanan","lastName":"Kilikkotte","suffix":""},{"id":406281026,"identity":"814f10f8-3e5c-41a6-8c73-1134742f461a","order_by":2,"name":"Aswin Kollamkandipalliyali","email":"","orcid":"https://orcid.org/0000-0001-6294-0995","institution":"Institute of Mental Health and Neurosciences","correspondingAuthor":false,"prefix":"","firstName":"Aswin","middleName":"","lastName":"Kollamkandipalliyali","suffix":""},{"id":406281027,"identity":"acabd28c-9bb9-4ab0-bc25-0b8666ddb3c0","order_by":3,"name":"Sudhir Kumar","email":"","orcid":"","institution":"Alzheimer’s and Related Disorders Society of India","correspondingAuthor":false,"prefix":"","firstName":"Sudhir","middleName":"","lastName":"Kumar","suffix":""}],"badges":[],"createdAt":"2025-01-23 17:02:09","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5890068/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5890068/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74898065,"identity":"aca52118-4581-4e71-8d56-2a037b4e6ca6","added_by":"auto","created_at":"2025-01-28 06:50:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":588880,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5890068/v1/f566e390-0457-4c1d-8a14-42cd7fe07492.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eCharacteristics and Satisfaction with Services of Patients Attending A Geriatric Psychiatry Clinic in Southern India\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA phenomenal increase in the global older adult population to 1.4\u0026nbsp;billion in 2030 and to 2.1\u0026nbsp;billion in the next three decades has been predicted by WHO (2024) One of every six people is aged 60 years or over. Developing countries such as India will be home to two-thirds of them. The International Institute for Population Sciences \u0026amp; United Nations Population Fund, in its 2023 India Ageing Report, estimates the decadal growth rate of India's older adults population to be 41%, and this is predicted to double to over 20% of the total population by 2050 in the country.\u003c/p\u003e \u003cp\u003eAround 14% of adults aged sixty and over live with a mental disorder (Institute of Health Metrics and Evaluation, 2024), which is often underrecognized and undertreated, and the stigma makes people reluctant to seek help. Psychological and physical disorders frequently coexist among older adults, which increases the disability. Evaluating and addressing the social determinants impacting the mental health of older adults, which include stigma against mental illnesses, mental health care disparity, ageism and social isolation, and loneliness at individual and community levels, is critical for the prevention of mental disorders and enhancement of well-being in the older adults (Reynolds et al., 2022). According to the National Mental Health Survey of India, older adults had a higher weighted lifetime (15.1%) and current (10.9%) prevalence of any psychiatric morbidity, as compared to the younger population (13.4% and 10.5%, respectively) (Sinha et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). With the gradual breakdown of joint families, changing value systems, and urbanization on a background of inadequate older adult's welfare measures initiated by the government, there is an emerging need to pay greater attention to older adult's care and older adults mental health issues (Khandelwal \u0026amp; Pattanayak, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). There is a huge treatment gap due to several reasons, including poor recognition of the seriousness of the disability it produces. Many countries have addressed this issue by providing specialized services to the elderly population with mental disorders using a multidisciplinary approach. The United Nations declared 2021\u0026ndash;2030 as the Decade of Healthy Aging, and the World Health Organization proposes to secure person-centered integrated healthcare and provide access to long-term care as one of the four major target areas. A comprehensive assessment of the older person\u0026rsquo;s mental health, physical health, social circumstances, medical history, and medications to reach a formulation that spans the biopsychosocial spectrum is often beyond the scope and interest of a generic psychiatric clinic.\u003c/p\u003e \u003cp\u003eMultidisciplinary geriatric psychiatry services are best placed to address the following unique challenges. Mental disorders of old age are heterogeneous at multiple levels; etiopathogenesis, clinical presentation, and response to intervention reflect genetic, environmental, social, and developmental vulnerabilities and resilience, emphasizing the need for implementing personalized and effective treatment approaches (Reynolds et al., 2022). A bottom-up approach to geriatric mental health care has been proposed, which includes multidisciplinary care of older adults with dedicated outpatient services to provide integrated care as the need of the hour (Philip et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and there are guidelines on establishing them in various resource settings (ARDSI, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Geriatric psychiatry services provide comprehensive evaluation and diagnosis, medication management, psychotherapy, improved quality of life, and caregiver support. The older adults are distinct from younger individuals physically and psychologically. Cognitive decline related to age associated with brain shrinkage, increased risk of medication side effects, cultural factors impacting the mental health of older adults, social isolation, loss of independence, and changes in family dynamics are some of the factors that make the specialty unique (Morris, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn India, specialist services for older adults with mental health issues are few and far between, and when present, we do not have information about how satisfied the service users are (Grover et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Patient satisfaction with services is an important parameter to evaluate treatment outcomes, and healthcare services are moving towards a client-service provider model in India as well as from practices around the world and as mandated by the WHO under its quality rights initiative for mental health (Jena \u0026amp; Gupta, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Measurement of patient ratings of satisfaction with hospital services as a marker of quality in health care and as a tool for improving the quality of medical care has been well-established (Barak et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eAims and Objectives\u003c/h3\u003e\n\u003cp\u003e We aimed to look at the socio-demographic characteristics and clinical profile of the geriatric population accessing the multi-disciplinary led geriatric service in Kerala, explore patient and caregiver satisfaction with the multi-disciplinary geriatric service, and identify areas for improvement. The study evaluated the prevalence of comorbidities among the geriatric population accessing the service. The services provided by a multi-disciplinary team, challenges faced in service delivery, and their final impact on patient outcomes and satisfaction were looked into. Feedback on patient and caregiver experiences with the multidisciplinary approach, focusing on the quality of clinician care, emphasizing communication and joint decision-making, was explored. Based on the study's findings, look for potential areas for improvement and challenges in delivering multi-disciplinary geriatric mental health services.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA specific data sheet was used to transfer the sociodemographic and clinical details of patients who attended the weekly Geriatric Psychiatry Outpatient clinic at the Institute of Mental Health and Neurosciences, Calicut, Kerala, in southern India, from the period August 2023 to March 2024. The multidisciplinary team consists of a geriatric psychiatrist, senior resident, psychiatric social worker, neuropsychologist and clinical psychologist, psychiatric nurse, physiotherapist, speech and language therapist, and special educator. Patients can attend the clinic directly or via referrals from other clinicians or centers. The clinic uses a comprehensive proforma for assessment, including socio-demographic, clinical details, and assessment tools. After registration, patients are initially screened by the psychiatric nursing team with a brief assessment, including a general examination. The geriatric psychiatrist does a comprehensive assessment to make a diagnosis and formulate a care plan. The care plan is based on needs assessment, and referral to respective multi-disciplinary team members is facilitated. Multi-disciplinary team meetings are conducted monthly to discuss new referrals and challenging cases. The inputs from the psychologist include psychological and neuropsychological assessment, psycho-education, cognitive behavior therapy, cognitive retraining, interpersonal therapy, family therapy, stress management, caregiver support, etc. Social worker focuses on assessments and interventions for psychosocial issues, financial support, family therapy, caregiver support, legal support etc. Patients are reviewed every four weeks or earlier as appropriate. All services are offered free of cost.\u003c/p\u003e \u003cp\u003eThe Short Assessment of Patient Satisfaction (SAPS) scale is commonly used to evaluate patients' contentment with the services they receive. This concise, reliable, and valid seven-item tool effectively measures patient satisfaction regarding their treatment (Hawthorne et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The scale was carefully designed by selecting items that demonstrate the best measurement properties and provide the most comprehensive coverage of patient satisfaction domains. The SAPS evaluates key areas of satisfaction, such as treatment satisfaction, explanation of treatment results, clinician care, participation in medical decision making, respect by the clinician, time spent with the clinician, and overall satisfaction with hospital/clinic care. The scale employs a 5-point response system and has been validated in clinical environments (Hawthorne et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Sansoni et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) and is a valid and reliable measure of patient satisfaction. This scale can be applied in any service setting across various treatment groups. The interpretation of the scores is as follows: A score between 0 and 10 reflects significant dissatisfaction, suggesting that the patient feels their healthcare has failed them and they require urgent assistance. A score from 11 to 18 indicates general dissatisfaction, where patients are experiencing shortcomings in multiple aspects of their healthcare and need support in those areas. A score range of 19 to 26 suggests a level of satisfaction, but these patients should be further asked about specific areas of dissatisfaction to guide improvement efforts. Finally, a score of 27 to 28 signals a very high level of satisfaction, indicating that all aspects of care have either met or surpassed the patient's expectations.\u003c/p\u003e \u003cp\u003eMicrosoft Excel was used for data structuring, and statistical analysis was performed using IBM SPSS version 27. Descriptive statistics of frequency counts and percentages were used for categorical variables. Mean and standard deviation were calculated for continuous variables. Chi-square tests were used to test the difference between two proportions, and paired t-tests were used for continuous data. The difference was considered statistically significant when the p-value was less than 0.05. The study was reviewed and approved by the Ethics Committee of the IMHANS (Institute of Mental Health and Neurosciences), and participant confidentiality was maintained throughout the research.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of clinic attendees\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)/n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.91 (6.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (Range 55 to 86 years)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(36.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65 to 74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (42.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75 to 84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove 85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (51.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (48.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiving situation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLives with spouse only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (33.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLives with family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (58.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocio economic status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation in years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp to 7 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (55.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 to 14 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (27.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15 to 21 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (16.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove 21 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean education in the number of years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.21 (5.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eBetween August 2023 and March 2024, eighty patients attended the geriatric psychiatry outpatient clinic. Men and women were equal in numbers (40, 50%). The mean age of the attendees was 68.91 (SD\u0026thinsp;=\u0026thinsp;6.87), with a range of 55 to 86 years and a median of 67 years. The majority (34; 42.5%) of the patients were in the 65 to 74 age group, followed by 29 (36.3%) who were less than 65 years old.\u003c/p\u003e \u003cp\u003e41 (51.2%) patients were from a rural background, and 72 (90%) belonged to the middle socioeconomic category (72, 90%). Forty-seven (58.75%) attendees lived with their family members, while 27 (33.75%) with just their spouse. The mean education in the number of years of the attendees was 9.21 years (SD\u0026thinsp;=\u0026thinsp;5.84). 73 (91.3%) were new patients. Most (74; 92.5%) patients attended with a family member.\u003c/p\u003e \u003cp\u003eFifty-four (67.5%) patients had comorbid medical disorders; 25 (31.3%) had multiple diseases. Thirty (37.8%) had hypertension, followed by diabetes (22; 27.5%). Twenty-four (60%) females and 30 (75%) males had physical disorders. There was no statistically significant difference between genders in the presence of a medical diagnosis (p\u0026thinsp;=\u0026thinsp;0.152).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedical and psychiatric diagnoses of clinic attendees\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e\u003cb\u003eMedical Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (37.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (27.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypothyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDLP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParkinson\u0026rsquo;s Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e\u003cb\u003ePsychiatric Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (17.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild Cognitive Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrganic Affective disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBipolar disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObsessive Compulsive disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjustment disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (17.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomatoform disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (11.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most common psychiatric diagnosis was dementia and adjustment disorder (14; 17.5%). Eight (10%) patients each had depression and anxiety disorders. Four (28.6%) patients with dementia were less than 65 years old, while 5 (35.7%) belonged to the age group 65 to 74 years. Four (28.6%) of them were in the age category 75 to 84 years, and one (7.1%) patient was above the age of eighty-five. Adjustment disorder (7; 50%) was most common in the age group 65 to 74 years. Depression (4;50%) and anxiety disorders (3; 37.5%) had an equal distribution between those who were less than sixty-five years old and those in the 65 to 74 years age category.\u003c/p\u003e \u003cp\u003eRegarding treatment, 48 (60%) were prescribed psychotropic medications: 21 (26.3%) on antipsychotics, 37 (46.3%) on antidepressants, and 14 (17.5%) on benzodiazepines. The most common antipsychotics prescribed were risperidone and olanzapine (8; 38.1%) followed by quetiapine (6; 28.6%). Escitalopram and mirtazapine (13; 35.1%) were the most frequently used antidepressants, followed by fluoxetine and sertraline (4; 10.8%). Clonazepam (13; 92.9%) was the most frequent choice as a sedative-hypnotic. As mood stabilizers, lithium was prescribed for two patients and sodium valproate for one patient.\u003c/p\u003e \u003cp\u003eAmong 14 patients who had dementia, 11 (78.6%) patients were on medications for dementia. Among medications for dementia, donepezil was prescribed for five (45.5%) patients, memantine for three, and a combination of them also for three (27.3%) patients. 4 (28.6%) were on antipsychotics for behavioral and psychological symptoms, which were severe and non-responsive to psychosocial interventions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDetails of medications prescribed to the clinic attendees\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrescriptions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eAntipsychotics (n\u0026thinsp;=\u0026thinsp;21)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmisulpiride\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAripiprazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClozapine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOlanzapine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (38.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuetiapine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (28.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRisperidone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (38.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eAntidepressants (n\u0026thinsp;=\u0026thinsp;37)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDesvenlafaxine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEscitalopram\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (35.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluoxetine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMirtazapine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (35.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSertraline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrazadone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVenlafaxine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDementia medications (n\u0026thinsp;=\u0026thinsp;11)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDonepezil only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (45.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMemantine only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDonepezil and Memantine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBenzodiazepenes (n\u0026thinsp;=\u0026thinsp;14)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClonazepam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (92.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiazepam 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThirty-eight (47.5%) patients were referred for inputs by psychiatric social workers who were trained for various therapeutic interventions, which included supportive therapy, family therapy, and geriatric wellbeing groups. Twenty\u0026ndash;two (27.5%) patients for clinical psychology inputs, including assessments, cognitive behavior therapy, etc. Three (3.8%) declined psychosocial interventions. Two (2.5%) patients received interventions from other professionals like physiotherapy.\u003c/p\u003e \u003cp\u003eFollow-ups are arranged between one week and 8 weeks. Most are scheduled for a visit after 4 weeks (26, 32.5%), followed by 6 weeks for 17 (21.3%) patients.\u003c/p\u003e \u003cp\u003eMost patients were \u0026lsquo;very satisfied\u0026rsquo; with the service, 47 (58.8%) scoring 27 or 28 on SAPS, where the maximum score is 28. Twenty-eight patients (35.0%) were \u0026lsquo;satisfied\u0026rsquo; with the service, scoring between 19 and 26. One patient was dissatisfied with the service. The mean score was 26.01 (SD\u0026thinsp;=\u0026thinsp;2.77). There was no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.390; df\u0026thinsp;=\u0026thinsp;74) in the total satisfaction score between men (26.32, SD\u0026thinsp;=\u0026thinsp;2.73) and women (25.72, SD\u0026thinsp;=\u0026thinsp;2.81). There was no statistically significant relationship between education in a number of years and total satisfaction score (p\u0026thinsp;=\u0026thinsp;0.558).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScores of Short Assessment of Patient Satisfaction scale items\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAPS Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow satisfied are you with the effect of your {treatment/care}\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow satisfied are you with the explanations the {doctor/other health professional} has given you about the results of your {treatment/care}?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe {doctor/other health professional} was very careful to check everything when examining you.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow satisfied were you with the choices you had in decisions affecting your health care?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow much of the time did you feel respected by the {doctor/other health professional}?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe time you had with the {doctor/other health professional} was too short.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAre you satisfied with the care you received in the {hospital/clinic}?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAfter the Second World War, a rapidly aging society led to end the increased prevalence of dementia. This led to geriatric psychiatry as a distinct professional entity in the latter part of the 20th century across North America and Europe (Ballenger, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Grover et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) report a lack of geriatric mental health services and minimal attention to geriatric psychiatry as a subspeciality during training. The need for geriatric psychiatric clinics was recognized early on (Ghosh, 2006) as the presentation of psychiatric illnesses among the elderly differs from that of adult patients. Additionally, physical illness often presents with psychological symptoms and vice versa. Along with the natural ageing of the brain, various factors contribute to psychological issues among the older adults in India. These include physical health problems, cerebral pathology, and socio-economic challenges such as the disintegration of family support systems, social isolation, and reduced financial independence. These factors have been recognized as significant contributors to the burden of mental disorder morbidities faced by older adults in India (Guha, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1994\u003c/span\u003e). In addition to the unique needs geriatric populations have, there are a wide variety of challenges seen at different levels of care and treatment, from acceptance, help-seeking, and compliance (Lodha \u0026amp; De Sousa, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe multidisciplinary team in this clinic brings a blend of experience and skills to provide a comprehensive approach to treatment, care, and rehabilitation with a focus on recovery goals. A multidisciplinary team includes psychiatrists, psychologists, social workers, psychiatric nurses, occupational therapists, and other allied health professionals who as a team can conduct comprehensive assessments that include medical, psychological, psychosocial, and environmental factors and provide accurate diagnoses and tailored treatment plans. Each member of the multidisciplinary team, being experts in their area, can bring unique expertise and skills to the individual case. Clear delineation of the role of each member of the multidisciplinary team makes it effective. There is concidarable variability in how older adults respond to medications as well as psychosocial and psychotheraptic interventions, higliting the importance of personalized medicine.\u003c/p\u003e \u003cp\u003eIn this clinic, a patient-centered approach is utilized with a collaborative decision-making process among team members where treatment plans are tailored to the individual's preferences as appropriate. The multidisciplinary team also focuses on preventive strategies, early intervention, identifying risk factors, detecting problems at an early stage, and formulating risk management strategies, thus improving prognosis and treatment outcomes. Geriatric mental health issues often require long-term management and support, and a multidisciplinary team can provide continuity of care that is comprehensive and holistic. Encouraging healthy brain aging and cognitive fitness in the later years of life is also crucial. (Reynolds et al., 2022).\u003c/p\u003e \u003cp\u003eThe prevalence of mental disorders among the older adults varies depending on the setting, and tools used and the prevalence among this clinic sample is comparable to the reported rates (Pilania et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Rajkumar et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tiwari \u0026amp; Pandey, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The medication prescriptions adhere to the national guidelines (Avasthi \u0026amp; Grover, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Gautam et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Shaji et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)The clinic adopts the policy of following well-recognized guidelines in prescribing medications that are only necessary at appropriate doses, closely monitoring the side effects, and conducting periodic reviews.\u003c/p\u003e \u003cp\u003eClinicians working in geriatric psychiatry clinics benefit from having a substantial interest and skills in understanding coexisting physical disorders. Older adults experience a higher prelevence of multiple conditions such as diabetes, lung disease, and cardiovascular disase, older adults with mental health disorders and other co morbidities which are liked to early mortality, disability, and impered functioning (Adamis \u0026amp; Ball, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Bartels, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Specialized clinical settings can optimize the safety and efficacy of pharmacotherapy and pay specific attention to metabolic, cardiovascular, and neurological tolerability. (Reynolds et al., 2022) older adults face greater physical health burden, comorbidities, and premature mortality. Those with chronic and severe mental health issues are at risk, as situation often exacerbated by agisam in health care which is manifested by a lack of enthusiasm for diagnosis and treatment, as well as therapeutic nihilism.(WPA, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA wide variety of psychosocial interventions are provided in this clinic. Evidence-based psychosocial interventions (Samhsa, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) ), such as skills training programs, assist individuals in acquiring behavioral strategies to better manage their condition, develop independent living abilities, and enhance social interactions. Psychotherapy plays a key role in supporting individuals with mental health conditions by enhancing their daily functioning, well-being, and overall quality of life. Illness self-management approaches aim to strengthen an individual\u0026rsquo;s capacity to handle both physical and mental health challenges, fostering an active role in their recovery process. Additionally, interventions designed for families or caregivers focus on addressing their specific mental health needs and concerns, providing support to those who care for individuals with mental health conditions.\u003c/p\u003e \u003cp\u003eGeriatric clinics should have access to recommended (WHO, 2016) Psychosocial interventions include psychoeducation, psychological treatments, and interventions to reduce stress, strengthen social support, and promote functioning in daily activities. In addition to the provision of recommended psychosocial interventions in this clinic, geriatric well-being groups are conducted on a weekly basis on an open basis, which lasts for around two hours, where psychoeducation, supportive interventions, cognitive stimulation activities, etc are included. Patients attend three to four sessions and are welcome if they want to come back for more sessions.\u003c/p\u003e \u003cp\u003eThe majority (74; 92.5%) of patients attended the clinic with their family members, who are also informal caregivers, and the clinic focuses on their needs as well. Caregiver burden can be reduced by information and support. Caregivers of older individuals with mental disorders often experience significant burden and require both information and support. Involving them as informal members of the caregiving team offers mutual benefits for both the patient and the caregivers, while also enabling more accurate clinical assessments and targeted interventions to promote well-being and prevent serious negative outcomes. This highlights the importance of providing care that is not solely focused on the patient but also incorporates a family-centered approach (Reynolds et al., 2022). The concept of obligation and respect towards elders form the cornerstone for informal care which is a natural resource that is on the decline due to factors including the nuclearization of families, which necessitates facilitating formal systems of care for the older adult population (Shaji, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Multidisciplinary geriatric psychiatry clinics are in a position to support families in optimizing the mental health of older adults and working towards a recovery goal.\u003c/p\u003e \u003cp\u003eThe overall level of satisfaction among attendees here was higher than that reported by other outpatient services (Bandhu et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Satisfaction is linked to whether patients perceive the services provided as adequate and in line with their expectations. However, the exact process by which patients form satisfaction or dissatisfaction remains unclear, as satisfaction is generally thought to reflect how well their expectations of treatment have been met or surpassed. These expectations are largely shaped by the interpersonal aspects of care (Harris et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The clinic attendees suggested improving existing infrastructure for ease of access and more facilities for pharmacology and investigation.\u003c/p\u003e \u003cp\u003eMultiple forms of discrimination and stigma, including ageism (discrimination based on age) and mentalism (discrimination against individuals with mental disorders) (Peisah et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; WHO, 2002), as well as structural ageism\u0026mdash;age-based discrimination embedded in institutional policies, practices, behaviors, and procedures can be partially addressed through services like geriatric psychiatric clinics. Tackling the social determinants of health within an integrated healthcare approach is crucial for improving health outcomes and reducing existing disparities in the health of older adults (Perez et al., 2022) ). Social workers play a significant role in advancing these efforts.\u003c/p\u003e \u003cp\u003eA specialist service like a geriatric psychiatry clinic will be able to incorporate a cultural formulation, which newer diagnostic systems focus on. Cultural formulation acknowledges certain cultural themes that have special reference to the elderly (Sakauye, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and emphasizes the subjective expressions of the perception of the illness and its causes, their ideas about what would be helpful, and their level of comfort by the ideas put forward by the treating team.\u003c/p\u003e \u003cp\u003eThe lack of emphasis on the healthcare needs of older adults appears to contribute to the low level of public awareness regarding mental health issues in later life (Sathyanarayana Rao \u0026amp; Shaji, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). ). For a long time, older adults were viewed merely as an extension of the adult population, which resulted in limited research specifically focused on this age group in India. Consequently, healthcare services tailored to their needs were not prioritized. However, with a growing understanding that older adults are distinct psychologically, biologically, and socially, there has been a gradual shift in how they are approached (Tiwari \u0026amp; Pandey, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe challenges of limited awareness, inadequate training opportunities, unequal distribution of healthcare resources, and the near absence of chronic care models in geriatric psychiatry in India have led to increased efforts in raising awareness, building capacity, and strengthening training and research activities (Prakash \u0026amp; Kukreti, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Recommendations for future-proofing geriatric mental health services in India include urgently strengthening healthcare delivery systems through a comprehensive, multipronged approach, focusing on developing a well-trained workforce and improving infrastructure. It is also crucial to implement review mechanisms to ensure updates on best practices and evidence-based medicine, with periodic evaluations(Philip et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) In this context, specialized old-age mental health services are well-positioned to drive these efforts forward, offering both care and necessary training and clinical exposure for undergraduates and postgraduates. Collaborative care models between geriatric medicine specialists and psychiatrists can help deliver this model without placing additional strain on existing resources (Philip et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eConsidering the high prevalence and morbidity associated with mental disorders among older adults and the high level of satisfaction among those who use services specifically for them, there is an urgent need to establish more geriatric psychiatry clinics across India. The multidisciplinary approach will help in addressing the specific issues of this population, which may often be time-consuming and require the involvement of various professionals without having to compete with the younger population. There is a need to have quality indicators to evaluate the systems and processes involved in such specialist clinics to ensure the satisfaction of service users. They should be culturally sensitive and capable of offering appropriate comprehensive care and support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdamis, D., \u0026amp; Ball, C. (2000). Physical morbidity in elderly psychiatric inpatients: prevalence and possible relations between the major mental disorders and physical illness. \u003cem\u003eInternational Journal of Geriatric Psychiatry, 15\u003c/em\u003e(3), 248-253. https://doi.org/10.1002/(SICI)1099-1166(200003)15:3\u0026lt;248::AID-GPS102\u0026gt;3.0.CO;2-L \u003c/li\u003e\n\u003cli\u003eARDSI, A. s. a. R. D. S. o. I. (2024). \u003cem\u003eGuidelines for establishing memory clinics\u003c/em\u003e. Retrieved 2 November 2024 from https://ardsikottayam.wordpress.com/2024/08/21/memory-clinic-guidelines/\u003c/li\u003e\n\u003cli\u003eAvasthi, A., \u0026amp; Grover, S. (2018). 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Geriatric Psychiatry in India: Developments and Future Directions. In S. Malhotra \u0026amp; S. Chakrabarti (Eds.), \u003cem\u003eDevelopments in Psychiatry in India: Clinical, Research and Policy Perspectives\u003c/em\u003e (pp. 493-513). Springer India. https://doi.org/10.1007/978-81-322-1674-2_25 \u003c/li\u003e\n\u003cli\u003eLodha, P., \u0026amp; De Sousa, A. (2018). Geriatric mental health: The challenges for India. \u003cem\u003eJournal of Geriatric Mental Health, 5\u003c/em\u003e(1), 16-29. https://doi.org/10.4103/jgmh.jgmh_34_17 \u003c/li\u003e\n\u003cli\u003eMorris, D. L. (2001, 2001/12/01/). Geriatric mental health: An overview. \u003cem\u003eJournal of the American Psychiatric Nurses Association, 7\u003c/em\u003e(6), S2-S7. https://doi.org/10.1067/mpn.2001.120851 \u003c/li\u003e\n\u003cli\u003ePeisah, C., de Mendon\u0026ccedil;a Lima, C., Verbeek, H., \u0026amp; Rabheru, K. (2022, Nov). 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Addressing the mental health needs of India\u0026rsquo;s aging population: Understanding depression prevalence and social risk factors in tertiary care outpatients. \u003cem\u003eIndian Journal of Psychiatry, 65\u003c/em\u003e(9), 949-954. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_352_23 \u003c/li\u003e\n\u003cli\u003eReynolds, C. F., 3rd, Jeste, D. V., Sachdev, P. S., \u0026amp; Blazer, D. G. (2022, Oct). Mental health care for older adults: recent advances and new directions in clinical practice and research. \u003cem\u003eWorld Psychiatry, 21\u003c/em\u003e(3), 336-363. https://doi.org/10.1002/wps.20996 \u003c/li\u003e\n\u003cli\u003eSakauye, K. (2015, 2015/07//). 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(2002). \u003cem\u003eReducing stigma and discrimination against older people with mental disorders\u003c/em\u003e. Retrieved 13 November 2024 from https://www.who.int/publications/i/item/WHO-MSD-MBD-02.3\u003c/li\u003e\n\u003cli\u003eWHO, w. h. O. (2016). \u003cem\u003emhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (\u0026lrm;mhGAP)\u0026lrm;, version 2.0\u003c/em\u003e. Retrieved 12 November 2024 from https://www.who.int/europe/publications/i/item/9789241549790\u003c/li\u003e\n\u003cli\u003eWHO, W. H. O. (2024). \u003cem\u003eAgeing\u003c/em\u003e. World Health Organization (WHO). Retrieved 10 August 2024 from https://www.who.int/health-topics/ageing#tab=tab_1\u003c/li\u003e\n\u003cli\u003eWPA, w. P. A. (2023). \u003cem\u003eNewsletter of the Section of Old Age Psychiatry\u003c/em\u003e. Retrieved 12 August 2024 from https://www.wpanet.org/ec-news\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Institute of Mental Health and Neurosciences","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Geriatric, old age, outpatients, Dementia, Depression, Satisfaction, India, Kerala","lastPublishedDoi":"10.21203/rs.3.rs-5890068/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5890068/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSpecialist services like geriatric psychiatric clinics aim to provide a multidisciplinary and person-centred approach. There is not enough information available about the number and type of such clinics in India. In this descriptive paper, we aim to detail the services provided and the sociodemographic and clinical characteristics of patients who have attended the geriatric psychiatry outpatient clinic at the Institute of Mental Health and Neurosciences, Kerala, in Southern India. A specific data sheet was used to transfer the sociodemographic and clinical details of patients who attended the weekly Geriatric Psychiatry Outpatient clinic. The clinic uses a comprehensive proforma and assessment tool as appropriate. The Short Assessment of Patient Satisfaction Scale was used to assess the satisfaction with the services. Between August 2023 and March 2024, eighty patients attended the Geriatric Psychiatry Outpatient Clinic. Men and women were equal in numbers (40, 50%). The mean age of the attendees was 68.91 (sd=6.87). Sixty-four (80%) patients had comorbid medical disorders. The most common psychiatric diagnosis was dementia and adjustment disorder (14; 17.5%). Eight (10%) patients each had depression and anxiety disorders. Regarding treatment, 48 (60%) were prescribed psychotropic medications: 21 were (26.3%) on antipsychotics, 37 (46.3%) were on antidepressants, and 14 (17.5%) were on benzodiazepines. Most of the patients were ‘very satisfied’ with the service, 47 (58.8%) scoring 27 or 28 on SAPS, where the maximum score is 28. The multidisciplinary team in this clinic brings a blend of skills to provide a comprehensive approach to treatment, care, and rehabilitation.\u003c/p\u003e","manuscriptTitle":"Characteristics and Satisfaction with Services of Patients Attending A Geriatric Psychiatry Clinic in Southern India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-28 06:41:53","doi":"10.21203/rs.3.rs-5890068/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8a1902f0-85e4-4976-9ea9-0a5ea9349e22","owner":[],"postedDate":"January 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":43325946,"name":"Psychiatry"}],"tags":[],"updatedAt":"2025-01-28T06:41:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-28 06:41:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5890068","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5890068","identity":"rs-5890068","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}