title: Joint geriatric and old-age psychiatric wards in the U.K., 1940s-early 1990s: a historical study.
abstract: OBJECTIVE
  This study aims to investigate the history of joint geriatric-psychiatric units. For policy making and planning of high-quality clinical service models, clinical and social contexts need to be considered. Longitudinal, contextual information can be provided by historical analyses, including the successes and failures of earlier, similar services. Historical analyses complement clinical, randomised controlled studies and may contribute to ensuring optimum outcomes for future schemes.
  
  
  METHODS
  Standard historical methodology was used, including searching published sources and institutional and personal archives and conducting a 'witness seminar' and individual oral history interviews.
  
  
  RESULTS
  Proposals to create joint units have existed since 1947. Most clinically successful units were led by enthusiastic, dedicated clinicians. Joint units had the potential to provide appropriate assessment and treatment for patients with multiple disorders and education for staff and students. Joint units never became widespread.
  
  
  CONCLUSIONS
  Reasons for the limited success of joint geriatric-psychiatric units might have included personalities of individuals, administrative boundaries separating geriatrics and medicine, unequal numbers of geriatricians and old-age psychiatrists, varying professional ideologies about the meaning of 'integrated' services, lack of reciprocity for each other's inpatients and lack of government support. Identified stumbling blocks need to be considered when planning joint clinical schemes. If current research indicates benefits of integrated wards for patients and their families, there needs to be ways to ensure that personal factors and fashions of management or government re-prioritisation will not lead to their premature termination.
authors.affiliation: Institute of Contemporary British History, King's College, London, UK; Older People and Health Ageing Service Line, CNWL NHS Foundation Trust, Harrow, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hilton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005853:Geriatrics / Q000266:history* / Q000458:organization & administration; D006299:Health Services for the Aged / Q000266:history* / Q000458:organization & administration; D049673:History, 20th Century; D006757:Hospital Units / Q000266:history* / Q000458:organization & administration; D006801:Humans; D008297:Male; D011567:Psychiatric Department, Hospital / Q000266:history* / Q000458:organization & administration; D006113:United Kingdom
keywords: delirium; dementia; history; joint geriatric-psychiatric units; policy