1. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences Psychiatric illness in older people in general hospitals John Holmes Senior Lecturer in Liaison Psychiatry of Old Age University of Leeds

2. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences Why bother about a problem? If it is common If it affects outcomes

3. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences 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. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences And…

5. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences How common is psychiatric illness in older people in general hospitals?

6. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences 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. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences After a hip fracture…

8. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences You may be depressed…

9. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences If you have dementia…

10. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences …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. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences 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. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences 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. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences 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. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences The response of old age psychiatry? Community focused –CMHTs, day hospitals, clinics –Psychiatric wards (some general hospital based) –Increasingly community based

15. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences 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. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences 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. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences Initial response time (M-W U Test p<0.0001)

18. University of Leeds: Academic Unit of Psychiatry and Behavioural Sciences Current response time M-W U-test p=0.012