Search

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.

Objectives: To determine and prioritise what information dementia caregivers wish to know at the time of diagnosis and later on in the illness, and in what form this information should be presented., Method: 100 carers were recruited from community mental health teams (CMHT) and a memory clinic (MC). A semi-structured Carer Interview was administered covering possible symptoms and management., Results: Carers requested as much information as possible. There was no significant difference between CMHTs and the MC. After carers prioritised the information they wished to receive, we proposed a 'rule of threes'. At diagnosis, carers want information about what dementia is, medications available and behavioural and psychiatric symptoms of dementia. In an early follow-up appointment, they want information about services, the course of the illness and what to do in a crisis. In a later follow-up appointment, they want information about support groups, benefits, and financial and legal issues. At a later stage, they want information about psychological therapies, the effects of the illness on carers and complementary treatments. Most carers wish to receive information from a health professional, backed up by written information., Conclusions: The 'rule of threes' enables health professionals to make informed decisions about primacy of information and strategies to prevent carers becoming overloaded. Information should also be provided in written form and from support groups., (Copyright 2003 John Wiley & Sons, Ltd.)

At present one in five men and one in three women who reach the age of 65 in the UK today can expect to require 24-hour residential care. They are assessed according to needs as to the type of placement that is required. Little is known about the changing needs and symptoms of residential clients over 65 with mental health problems. The needs and neuropsychiatric symptoms of older people living in residential, nursing and hospital settings were assessed by standardized questionnaire. Seventy-seven residents were interviewed using the Camberwell Assessment of Needs for the Elderly (CANE) and the Neuropsychiatric Inventory (NPI). The mean CANE for all settings was high. The highest mean CANE was for a residential home and the lowest for a hospital setting. Similar settings had varying NPI and CANE. The data suggests that once placed, subjects needs and neuropsychiatric symptoms do not remain static. It may make both clinical and fiscal sense to reassess subjects. The development of more residential settings, which allow flexibility of degree of care, is recommended.