Better mental health care for older people in general hospitals

• United Kingdom

Department of Health (DH)

558715

01-09-2008

36

• Alzheimer’s disease and other dementias

Alzheimer Disease; Dementia, Mental Health

The double disadvantage of being old and mentally ill represents an important inequity that this work will seek to reduce. The overall aim of this project is to facilitate the design of an effective and acceptable general hospital service for physically ill older people who also have mental health conditions.

The specific research questions to be answered are:

– What are the effects of the mental health problems of older patients in general hospitals upon the care delivered and the outcomes of that care as perceived by the patients, their families, caregivers and advocates, the immediate ward staff, and co-patients (other inpatients without mental health problems)?

Regarding staff in general hospitals:

– What are staff’s concerns and anxieties about dealing with older patients with mental health problems, confidence in their own competence to deal with such patients?

– What is the prevailing organisational culture (hospital and ward level) regarding older people and what are the organisational systems and management practices for older people with mental health problems?

– What are staff’s suggestions for systems-level improvements to service delivery and for personal/ professional development?

We plan a 3 year study.

During the first two years we will undertake:

– A review of the literature.

– A series of case studies of patients in general hospital who also have mental health problems, their carers and advocates, and the staff looking after them.

– An interview study of general hospital staff’s confidence, competence and training and of the organisational and system factors that affect their ability to provide care for older people with mental problems.

During the final year:

A research synthesis will be performed. During this phase we will analyse the findings from the above studies. We also draw upon our literature review, and the findings emerging from our two related projects (our SDO-funded study into the care of people with dementia in specialist hospital settings, and our NIHR-funded prevalence and cohort study of patients admitted to general hospitals who also have mental health problems). We will make recommendations for changes to training, practice and management to improve the care of our target group of patients.

Dissemination of the findings will be undertaken. The outputs of our synthesis will be locally implemented as we develop and evaluate a specialist unit for such patients.

Understanding the extent and precise nature of their health care needs, and the impact that combined physical and mental health problems have on both outcomes and costs, should inform best practice, and support the business case for developing and commissioning better services. The perceptions and views of staff, and understanding the organisational culture, will be vital in determining how a successful service can be developed, commissioned, trained for, and sustained.

The majority of people admitted to hospital as an emergency are old, with non-specific presentations (such as a fall) and with complex needs. Lack of experience in planning for people with mental health needs can lead to unnecessary care home placement. Until recently, the predicament of this group of patients has barely been recognised or studied. Neither has the organisational culture, systems and management practice in general hospitals been studied adequately. The double disadvantage of being old and mentally ill represents an important inequity that this work will seek to reduce.

We plan a 3 year study.

During the first two years we will undertake:

– A review of the literature

– A series of case studies of patients in general hospital who also have mental health problems, their carers and advocates, and the staff looking after them

– An interview study of general hospital staff’s confidence, competence and training and of the organisational and system factors that affect their ability to provide care for older people with mental problems.

During the final year:

A research synthesis will be performed. During this phase we will analyse the findings from the above studies. We also draw upon our literature review, and the findings emerging from our two related projects (our SDO-funded study into the care of people with dementia in specialist hospital settings, and our NIHR-funded prevalence and cohort study of patients admitted to general hospitals who also have mental health problems). We will make recommendations for changes to training, practice and management to improve the care of our target group of patients

Dissemination of the findings will be undertaken. The outputs of our synthesis will be locally implemented as we develop and evaluate a specialist unit for such patients.

• Health and social care research