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Psychiatric illness in older people in general hospitals

Psychiatric illness in older people in general hospitals. John Holmes Senior Lecturer in Liaison Psychiatry of Old Age University of Leeds. Why bother about a problem?. If it is common If it affects outcomes. Older people are important. Two-thirds of general hospital beds High throughput

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Psychiatric illness in older people in general hospitals

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  1. Psychiatric illness in older people in general hospitals John Holmes Senior Lecturer in Liaison Psychiatry of Old Age University of Leeds

  2. Why bother about a problem? • If it is common • If it affects outcomes

  3. 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

  4. And…

  5. How common is psychiatric illness in older people in general hospitals?

  6. So… • It’s 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

  7. After a hip fracture…

  8. You may be depressed…

  9. If you have dementia…

  10. …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 30:921-929, 2000.

  11. 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

  12. Why? • Psychiatric illness is not recognised • 50% of delirium • Psychiatric illness is not treated when recognised • Treatability • Knowing about and delivering the right treatment

  13. 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

  14. The response of old age psychiatry? • Community focused • CMHTs, day hospitals, clinics • Psychiatric wards (some general hospital based) • Increasingly community based

  15. 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

  16. 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 doesn’t match morbidity • Several specialities under-represented

  17. Initial response time (M-W U Test p<0.0001)

  18. Current response time M-W U-test p=0.012

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