scholarly journals Consultation—liaison in an old age psychiatry service

1998 ◽  
Vol 22 (4) ◽  
pp. 217-220 ◽  
Author(s):  
Ruth Loane ◽  
Peter Jefferys
Keyword(s):  
Nursing Home ◽  
Retrospective Study ◽  
Hospital Admission ◽  
Social Services ◽  
Old Age ◽  
Care Facility ◽  
Continuing Care ◽  
Functional Disorder ◽  
Old Age Psychiatry

This retrospective study looks at the outcome of 71 consecutive liaison referrals. Placement was noted at three-month follow-up and further use of medical, psychiatric and social services, compliance with clinical management and recommendations was also measured. Nearly half the patients had dementia and about half had a functional disorder. In 90% of referrals the recommendations were followed. At three-month follow-up 17% had died, 26% had further medical hospital admission, 39% had moved into a continuing care facility (residential/nursing home), and over half had further contact with the old age psychiatry services.

scholarly journals A brief computerised discharge summary in old age psychiatry: general practitioner reactions

1990 ◽  
Vol 14 (6) ◽  
pp. 330-330 ◽  
Author(s):  
J. P. Wattis ◽  
David Protheroe
Keyword(s):  
General Practitioner ◽  
Old Age ◽  
Catchment Area ◽  
Discharge Summary ◽  
Medical Audit ◽  
Other Information ◽  
Old Age Psychiatry ◽  
Surgical Audit

In an attempt to provide data for medical audit, to standardise the information on discharge letters and to speed communication, a computerised discharge form was introduced for a catchment area of 20,000 people over 65 years. The programme, based on a surgical audit programme using DBASE II, was developed by one of us to run on an Amstrad PCW. This produced a discharge summary on a standard layout which gave the date of admission, the patient's name, date of birth and address as well as the consultant and GP's name. The patient's diagnosis (according to ICD-9), and a list of disciplines and facilities involved in follow-up preceded brief notes on history and progress. Date of discharge was followed by a list of medication and a space for ‘other information’. All this was contained on one side of A4 paper.

scholarly journals Should old age psychiatry develop memory clinics? A comparison with domiciliary work

2004 ◽  
Vol 28 (3) ◽  
pp. 78-82 ◽  
Author(s):  
S. Simpson ◽  
D. Beavis ◽  
J. Dyer ◽  
S. Ball
Keyword(s):  
Old Age ◽  
Clinical Implications ◽  
Memory Clinic ◽  
Retrospective Case ◽  
Memory Clinics ◽  
Old Age Psychiatry ◽  
Psychiatric Complications ◽  
To Receive ◽  
Case Note Review

Aims and MethodMemory clinics have become very popular in old age psychiatry and there is some pressure for them to be developed in old age services. However, there is little evidence to suggest that they are more advantageous over the traditional domiciliary visits or who should be seen in clinic. This was a naturalistic comparison of 76 consecutive new referrals to a memory clinic, with 74 consecutive new domiciliary requests within the same service over the same period of time. A retrospective case note review collected the clinical features and an 18-month prospective follow-up examined the subsequent clinical management.Clinical ImplicationsThe two groups were characterised more by their similarities than their differences. However, the domiciliary group had greater behavioural and psychological complications. The memory clinic patients were less likely to receive psychotropic medication and here more likely to be followed up.ResultsWe conclude that memory clinics might be less suitable for patients with prominent psychiatric complications. Memory clinics could complement the domiciliary model by providing early psychosocial/neuropsychiatric approaches, although this is likely to lead to an increased clinical case-load.

Principles of service provision in old age psychiatry

2013 ◽  
Author(s):  
Tom Dening
Keyword(s):  
Older People ◽  
Social Services ◽  
Old Age ◽  
Memory Assessment ◽  
Policy Context ◽  
Effective Care ◽  
Challenges And Opportunities ◽  
Old Age Psychiatry ◽  
Fair Access

This chapter outlines the history, underlying principles and policy context for contemporary mental health services for older people. The usual components of such services, including community health teams, memory assessment services, day facilities, consultation-liaison services in general hospitals, and in-patient psychiatric care for older people are all discussed. Alongside these more familiar elements however, there have been other recent, sometimes destabilising, changes, including moves towards age-inclusive services and changes in working patterns for psychiatrists and other professionals. Working closely with primary care, greater integration with social services and providing support to care homes are all part of the current agenda. It is important to measure the quality of services and to ensure the populations who may be disadvantaged receive fair access to effective care and treatment. Obviously, the future increase in the numbers of very old people brings both challenges and opportunities for old age psychiatry services.

Fund-holding general practices and old age psychiatry

1994 ◽  
Vol 18 (5) ◽  
pp. 263-265 ◽  
Author(s):  
Christopher F. Fear ◽  
Howard R. Cattell
Keyword(s):  
Retrospective Study ◽  
General Practitioner ◽  
Old Age ◽  
Local Practices ◽  
Old Age Psychiatry ◽  
General Practices

In a retrospective study, referrals to a community old age psychiatry service were obtained for local practices a year before and a year subsequent to the introduction of prospective general practitioner (GP) fund-holding. Although overall patterns of referral were the same, there was a significant reduction in domiciliary consultations requested by fund-holding GPs which was not balanced by a rise in other referrals. The findings suggest a shortfall in the number of referrals to old age psychiatry services in the light of GP fund-holding, prompting speculation as to the fate of those who would otherwise have been referred.

Prognosis of depression in the elderly

1995 ◽  
Vol 12 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Aideen Freyne ◽  
Margo Wrigley
Keyword(s):  
Retrospective Study ◽  
The Elderly ◽  
Primary Diagnosis ◽  
Close Monitoring ◽  
Physical Status ◽  
Point Scale ◽  
Factors Associated ◽  
Old Age Psychiatry ◽  
Minimum Followup

AbstractObjective: To ascertain the outcome of depression and factors associated with outcome over a minimum followup period of 12 months in patients referred to an Old Age Psychiatry Service.Method: A retrospective study was performed. All depressed patients assessed by the service between January 1989 and December 1990 were followed up. This included patients seen on domiciliary and consultationliaison visits. Follow up data included information on physical, psychological, cognitive and social parameters using standardised scales where appropriate. Outcome of depression was assessed using a six point scale to enable comparison with other studies.Results: 86 patients with a primary diagnosis of depression were seen in 1989 and 1990. At follow up, 37% were dead. 50% of patients alive at follow up were well and 7% were demented. Patients seen on domiciliary visits had the best outcome, and those with physical illness or cognitive impairment at presentation the worst outcome.Conclusion: The association between physical status and outcome highlights the need for close monitoring of both physical and mental status of depressed elderly patients.

A study of severe domestic squalor: 173 cases referred to an old age psychiatry service

2010 ◽  
Vol 23 (2) ◽  
pp. 308-314 ◽  
Author(s):  
John Snowdon ◽  
Graeme Halliday
Keyword(s):  
Old Age ◽  
Referral Rate ◽  
Term Care ◽  
Old Age Psychiatry ◽  
One Year ◽  
Severe Degree ◽  
Made In ◽  
At Home

ABSTRACTBackground: Although community psychiatric services commonly encounter cases where intervention is needed due to persons’ unclean or cluttered living conditions, evidence concerning the referral rate and prevalence of severe domestic squalor is sparse.Methods: Between 2000 and 2009, ratings of cleanliness and clutter have been made in all cases of people living in squalor who have been referred to an old age psychiatry service in Central Sydney. Where possible, one-year follow-up was arranged.Results: 173 persons aged 65 years or more were referred to the service during the ten years and assessed as living in squalor (120 moderate or severe, two thirds of whom showed a moderate or severe degree of hoarding/clutter). Of 157 followed up after one year, 47% were still at home, 32% were in long-term care homes, 12% had moved elsewhere, and 9% had died. The annual new referral rate was close to 1 per 1000 elderly people in the catchment area, and of moderate or severe squalor was 0.66 per 1000. Limiting follow-up to those in moderate or severe squalor, 41% were still at home one year later. Current findings suggest that the minimum prevalence in the community of older people living in moderate or severe squalor in Sydney is 1 per 1000.Conclusions: The costs of intervening in cases of severe domestic squalor are considerable. Increased attention and funding are warranted, as the incidence and prevalence are higher than had previously been estimated.

scholarly journals Demographics, Clinical Characteristics, and Therapeutic Approaches among Older Adults Referred to Mobile Psychiatric Crisis Intervention Teams: A Retrospective Study

2018 ◽  
Vol 8 (3) ◽  
pp. 402-413
Author(s):  
Estelle Gillès de Pélichy ◽  
Karsten Ebbing ◽  
Alcina Matos Queiros  ◽  
Cécile Hanon ◽  
Armin von Gunten ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Old Age ◽  
Older Adult ◽  
Medical Records ◽  
Challenging Behaviors ◽  
Adult Patients ◽  
Intervention Teams ◽  
Psychiatric Crisis ◽  
Old Age Psychiatry

Background / Aims: The advent of mobile old age psychiatry intervention teams supports policies maintaining older adults in their habitual living environments, even those who are very old and suffering from acute cognitive and psychiatric impairments. Analyzing sociodemographic data, clinical and health characteristics, reasons for crisis-oriented psychiatric consultations, and other therapeutic suggestions for supporting home- or nursing home-dwelling older adult patients suffering from an onset of a psychiatric crisis. Methods: Reviews of the medical records and discharge letters of home- or nursing home-dwelling older adults who had undergone a consultation with the Lausanne region’s Mobile Old Age Psychiatry Teams (MOAPTs), between May 2016 and December 2017. Results: Of 570 older adult patients referred for consultation with MOAPTs, 333 had medical records and discharge letters eligible for retrospective analysis (59%). The majority of these older adult patients were women aged over 80 years suffering from dementia, mood disorders with and without a risk of suicide, and delirium. Challenging behaviors related to different stages of cognitive impairment were the most important clinical reason for crisis consultations. Nonpharmacological and pharmacological treatments were delivered concurrently in 68% of crisis consultations. Conclusion: Appropriate responses by dual nurse-psychiatrist teams using crisis-oriented nonpharmacological and pharmacological interventions decreased hospitalization.

Psychotropic prescribing in the oldest old attending a geriatric psychiatry service: a retrospective, cross-sectional study

2013 ◽  
Vol 30 (3) ◽  
pp. 187-196
Author(s):  
E. Kolshus ◽  
A. Freyne ◽  
I. Callanan ◽  
C. Cooney
Keyword(s):  
Nursing Home ◽  
Old Age ◽  
Oldest Old ◽  
Psychiatric Morbidity ◽  
Inappropriate Prescribing ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional ◽  
Common Diagnosis ◽  
Old Age Psychiatry

ObjectiveMore people are living beyond their 90s, yet this group has not been much studied. This study aimed to describe a sample of non-agenarians and centerians attending an old age psychiatry service with a focus on pharmacotherapy.MethodsRetrospective, cross-sectional survey of patients aged >90 in contact with the Department of Old Age Psychiatry in a university hospital over a 1-year period. Results were compared with the Beers, the Canadian and Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria.ResultsA total of 65 nonagenarians or centerians were identified (mean age 93, 82% female). The majority (65%) resided in a nursing home; dementia was the most common diagnosis (77%), followed by depression (29%). The most commonly prescribed psychotropics were antidepressants (58%), followed by antipsychotics (45%), hypnotics (42%), anti-dementia agents (31%) and anxiolytics (26%). Overall, patients were on a mean of 2.1 (S.D. 1.3, range 0–5) psychotropics and 4.99 (S.D. 2.7, range 0–11) non-psychotropics. Mean Mini Mental State Examination (MMSE) score was 15 (S.D. 8.1). Increasing anticholinergic burden was negatively associated with MMSE scores (B = −1.72, p = 0.013). Residing in a nursing home was associated with a higher rate of antidepressant [OR 5.71 (95% CI 1.9–17.4)], anxiolytic [OR 13.5 (95% CI 1.7–110.4)] and antipsychotic [OR 3.4 (95% CI 1.1–10.4)] use. Potentially inappropriate prescribing included long-term benzodiazepine use (26%) and long-term antipsychotic use (25%).ConclusionsOur sample had a high psychiatric morbidity burden with high levels of psychotropic use. Ongoing review and audit of psychotropic use in elderly patients can identify potentially inappropriate prescribing in a group vulnerable to high levels of polypharmacy and extended psychotropic use.

scholarly journals Information and advice received by carers of younger people with dementia

1999 ◽  
Vol 23 (2) ◽  
pp. 94-96 ◽  
Author(s):  
Hilary J. Husband ◽  
Meera N. Shah
Keyword(s):  
Social Services ◽  
Old Age ◽  
Comparison Group ◽  
Structured Interview ◽  
Clinical Implications ◽  
Advice Giving ◽  
Lack Of Information ◽  
People With Dementia ◽  
Adult Psychiatry ◽  
Old Age Psychiatry

Aims and methodRetrospective information on advice and information received post-diagnosis was obtained from 40 carers of younger people with dementia, using a semi-structured interview.ResultsTwelve carers received services from old age psychiatry, the remaining 28 from predominantly adult psychiatry or neurology. Those in receipt of old age services reported greater adequacy of diagnostic information, higher levels of advice giving and more frequent referral to social services.Clinical implicationsWhile old age services were more successful on the parameters examined, the gradually emergent nature of the diagnosis may be a crucial factor in the lack of information and advice received by the comparison group.

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