Psychiatric illness in older people in general hospitals

1
Psychiatric illness in older people in general
hospitals

• John Holmes
• Senior Lecturer in Liaison Psychiatry of Old Age
• University of Leeds

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Why bother about a problem?

• If it is common
• If it affects outcomes

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Older people are important

• Two-thirds of general hospital beds
• High throughput
• 20,000 non-scheduled admissions to LTHT
• Leeds population 750,000
• 110,000 aged 65 years or over

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And
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How common is psychiatric illness in older people
in general hospitals?
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So

• Its common
• But is it bad for you?
• Outcomes of interest
• Mortality
• Length of stay
• Institutionalisation
• Persistent symptoms
• Resulting in
• Poorer quality of life
• Or no life at all

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After a hip fracture
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You may be depressed
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If you have dementia
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and if you have delirium
J. Holmes and A. House. Psychiatric illness
predicts poor outcome after surgery for hip
fracture a prospective cohort study.
Psychological Medicine 30921-929, 2000.
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And as for survival
S. Nightingale, J. Holmes, J. Mason, and A.
House. Psychiatric illness and mortality after
hip fracture. Lancet 357 (9264)1264-1265, 2001
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Why?

• Psychiatric illness is not recognised
• 50 of delirium
• Psychiatric illness is not treated when
  recognised
• Treatability
• Knowing about and delivering the right treatment

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But

• The NSF calls for the right skill-mix to meet the
  need in general hospitals
• Though psychiatric staff are not routinely found
  there
• and general hospital staff do not have the
  knowledge, skills and attitudes

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The response of old age psychiatry?

• Community focused
• CMHTs, day hospitals, clinics
• Psychiatric wards (some general hospital based)
• Increasingly community based

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Although

• 25 to 33 of all old age psychiatry referrals
  from general hospitals
• Diagnosis, investigation, treatment of mental
  illness
• Assess capacity
• Arrange follow-up
• Take over take away

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And

• Increased numbers of referrals
• Pressure on acute beds
• Changing patterns of reason for referral
• More ill, older, frailer people in hospital
• External influences (e.g. social services)
• Concerns over consent and capacity
• Referral pattern doesnt match morbidity
• Several specialities under-represented

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Initial response time
(M-W U Test plt0.0001)
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Current response time
M-W U-test p0.012