Bristol & South Gloucestershire Older People’s Mental Health Liaison

1. Bristol & South Gloucestershire Older People’s Mental Health Liaison

2. Bristol & South Gloucestershire Older People’s Mental Health Liaison Typical district general hospital with 500 beds will admit 5000 older people per year 3000 will suffer a mental disorder. On average, older people will occupy 330 of 500 beds at any time and 220 of these will have a mental disorder. Who Cares Wins. Improving the outcome for older people admitted to the general hospital: Guidelines for the development of Liaison Mental Health Services for older people. 2005

3. This means that the acute hospital will have at least four times as many older people with mental disorder on its wards as the older people’s mental health service has on theirs.

4. Three disorders: depression, dementia and delirium account for 80% of this mental disorder. In a 500 bed hospital: • 96 patients will have depression • 102 have dementia • 66 have delirium

5. Mental disorder in this population is an independent predictor of poor outcome: • increased mortality • greater length of stay • loss of independent function • higher rates of institutionalisation

6. What is needed? • improved recognition (50% unidentified) • improved assessment • improved treatment and care management • improved partnerships between health care and social care • improved education and training of staff

7. Widow, 80, lives alone Mild dementia (not identified) Chest infection GP sends to hospital …“hospital acquired confusion” Stays in for 3 months Despondent Reduced mobility, weight loss, “unsafe to return home” Discharged to a care home www.intercom.net/~terrypl/photographypage

8. Widow, 80, lives alone Mild dementia (not identified) Chest infection GP sends to hospital …“hospital acquired confusion” Joint working with ward, liaison and social work departments Discharged home with home care support after 10 days www.plunge.com

9. What we do: • triaged by mental health liaison nurse • discussed in team meeting with Consultant • reassurance, management and medication • collaboration with social work department on: risks and needs capacity to make decisions • mental health support on discharge (if needed)

10. An ideal team would include: • nursing • medical • occupational therapy • psychology • physiotherapy • social work

11. Benefits for the patient: • dignity • independence • reduced length of stay (by 3.6 DAYS in BRI) • early access to treatment and care: anti-dementia drugs medication management support for carers social care

12. Benefits for the hospital: • increases bed availability reduced length of stay, cost-effective • does not discriminate by age basic care liaison services • sense of mastery for staff training, education, skills, job satisfaction

13. You decide!