A UK survey of psychiatric services for older people in general hospitals.
BACKGROUND
Psychiatric illness is common in older people in general hospitals, but little is known of the service models operating in the UK, or of the views of old age psychiatrists regarding service provision in this area. We set out to determine the range of UK old age psychiatry service models for older people in general hospital wards, and the opinions of clinicians on future service priorities and development.


METHODS
A postal questionnaire survey of old age psychiatrists providing psychiatric services to older people in general hospital wards.


RESULTS
73% of services were provided through a generic, sector-based, consultation psychiatry model. The remaining 27% employed a range of general hospital-based liaison psychiatry services for older people, involved in proactively seeking referrals and educating general hospital staff. Those providing a generic sector-based model were significantly slower at responding to referrals. 89% of respondents were unhappy with their service to older people in general hospital wards, with only 11% preferring the generic sector-based model. Organisational barriers to change identified included the management of mental health care and physical care by different organisations. Training, both of psychiatric staff in this specialist area, and of general hospital staff in the detection and basic management of common psychiatric conditions in the general hospital setting, was felt to be necessary.


CONCLUSIONS
The management of co-morbid psychiatric and physical illness in older people is an important issue for health services. Old age psychiatrists are unhappy with the prevalent, reactive, consultation-based model, preferring a range of liaison psychiatry models based in the general hospital. The most important barriers to service development in this area were the separate managerial arrangements for psychiatric and physical care services, and a lack of evidence for effective old age psychiatry services in this setting.
Holmes
John
J
University of Leeds School of Medicine, Academic Unit of Psychiatry and Behavioural Sciences, Leeds, UK. j.d.holmes@leeds.ac.uk
Bentley
Kris
K
Cameron
Ian
I
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005852:Geriatric Psychiatry / Q000193:education / Q000458:organization & administration*; D019538:Health Care Surveys; D006299:Health Services for the Aged / Q000458:organization & administration* / Q000592:standards / Q000600:supply & distribution; D006760:Hospitalization; D006769:Hospitals, General / Q000458:organization & administration*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards / Q000600:supply & distribution; D017146:Models, Organizational; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D006113:United Kingdom