title: Delayed discharge--a solvable problem? The place of intermediate care in mental health care of older people.
abstract: The National Service Framework for Older People envisages the development of intermediate care for older people. This study examined the possible role of intermediate care beds within mental health trusts. We interviewed senior clinicians in an inner city old age psychiatry service about the 91 current in-patients on the old age psychiatric wards. Sixty-five were classified as acute patients and the remaining 26 were continuing care patients. Structured instruments were used to collect information regarding neuropsychiatric symptoms, activities of daily living and current met and unmet needs. Where discharge was delayed an assessment was made regarding the appropriateness for an intermediate care setting according to the criteria set by the Department of Health guidelines. A total of 30 (46%) patients' discharges were delayed. Of these, 19 (29%) patients met the DOH criteria for intermediate care; 10 (53%) had dementia, five (26%) affective disorder, and four (21%) with schizophrenia. The 11 other delayed discharges were because of lack of availability of finance for placements. The study found that the prompt discharge of older patients from acute psychiatric care was a significant problem and many of those patients may benefit from the therapeutic and rehabilitative process afforded by intermediate care.
authors.affiliation: Department of Psychiatry, University College London, Highgate Hill, UK. j.paton@ucl.ac.uk
authors.forename: J M
authors.initials: JM
authors.lastname: Paton
authors.forename: M A
authors.initials: MA
authors.lastname: Fahy
authors.forename: G A
authors.initials: GA
authors.lastname: Livingston
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000534:rehabilitation; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D007380:Intermediate Care Facilities / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D020380:Needs Assessment / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D012040:Regional Health Planning / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000453:epidemiology* / Q000534:rehabilitation; D013222:State Medicine / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*