Bristol & South Gloucestershire

Older People’s Mental Health Liaison

 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
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison

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

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
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison

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
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison

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
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison

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
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison

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
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison

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)
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison

An ideal team would include:

• nursing
• medical
• occupational therapy
• psychology
• physiotherapy
• social work
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison
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
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison
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
 Bristol & South Gloucestershire
Older People’s Mental Health Liaison

You decide!