ABSTRACT

BACKGROUND:

a high prevalence of co-morbid mental health problems is reported among older adults admitted to general hospitals.

Setting: an 1,800 bed teaching hospital.

Design:

• Consecutive general medical and trauma orthopaedic admissions aged 70 or older were screened for mental health problems.
• Those screening positive were invited to undergo further assessment, and were interviewed to complete a battery of health status measurements.

RESULTS:

• of 1,004 patients screened, 36% had no mental health problems or had anxiety alone.
• Of those screening positive 250 took part in the full study.

Adjusting for the two-stage sampling design,

• 50% of admitted patients over 70 were cognitively impaired,
• 27% had delirium and 8–32% were depressed.
• Six percent had hallucinations,
• 8% delusions,
• 21% apathy and
• 9% agitation/aggression (of at least moderate severity).

Of those with mental health problems,

• 47% were incontinent,
• 49% needed help with feeding and
• 44% needed major help to transfer.

Interpretation:

• we confirm the high prevalence of mental health problems among older adults admitted to general hospitals.
• These patients have high levels of functional dependency, psychological and behavioural problems which have implications for how they are cared for.
• Services that identify these problems and offer therapeutic intervention should be evaluated.

Key words

• prevalence
• older person
• mental health
• general hospital
• cognitive impairment
• elderly

Previous Section Next Section

INTRODUCTION

Sixty percent of patients over 65 in general hospital beds have, or will develop, a mental health problem, including dementia, delirium and depression [1].

Mental health problems are associated with worse outcomes [2, 3], family carers report dissatisfaction with services [4, 5] and many general hospital staff feel ill-equipped to assess or manage these needs [4].

The National Dementia Strategy called for improvements in care for people with dementia admitted to hospital, better leadership and education and provision of psychiatric liaison services [6].

Previous studies have focused on specific mental health diagnoses [1], which general hospital staff struggle to identify accurately. There is little research describing patients with mental health problems in terms of their psychiatric symptoms, behaviour and functional abilities.

This study aimed to describe the current prevalence of these problems among people aged 70 and over admitted to hospital as an emergency, to help inform ward staffing levels and skill mix planning.

Age Ageing (2012) 41 (1): 80-86. doi: 10.1093/ageing/afr106

1. Sarah E. Goldberg1⇓,
2. Kathy H. Whittamore1,2,
3. Rowan H. Harwood1,2,
4. Lucy E. Bradshaw1,
5. John R. F. Gladman1,
6. Rob G. Jones3,4

On behalf of the Medical Crises in Older People Study Group

+ Author Affiliations

1. ¹Division of Rehabilitation and Ageing, University of Nottingham, Nottingham NG7 2UH, UK
2. ²Health care of Older People, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham NG7 2UH, UK
3. ³Division of Psychiatry, University of Nottingham, Nottingham NG7 2UH, UK
4. ⁴Mental Health Services for Older People, Nottinghamshire Healthcare NHS Trust, Queens Medical Centre, Nottingham NG7 2UH, UK

Address correspondence to: S. E. Goldberg. Tel: (+44) 0115 823 0238; Fax: (+44) 0115823 0231. Email: sarah.goldberg@nottingham.ac.uk