Confused, Dependent and Challenging

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1 Confused, Dependent and Challenging The Prevalence of Mental Health Problems Amongst Older Adults Admitted to a General Hospital Sarah Goldberg

2 Disgraceful care leaves dementia patients in worse condition The Times - 17 November 2009

3 60% The percentage of older people in hospital with mental health problems

4 Aims To describe the types and prevalence of mental health problems faced by older patients together with their functional and psychological and behavioural problems.

5 Methods Population Wards Screened for Consecutive admissions Large general hospital Aged 70 Healthcare of the Elderly Acute Medical Trauma Orthopaedics Cognition Depression Other

6 Baseline Measurements Cognition Delirium Depression Functional Dependency Behavioural & Psychological Problems Nutritional State MMSE Delirium Rating Scale Cornell Scale for Depression in Dementia Barthel Neuropsychiatric Inventory Mini Nutritional Assessment

7 RESULTS 1578 Approached 1004 Screened 643 Screened Positive 250 Recruited

8 Characteristics of Screened Population Trauma (n=197) Medical (n=414) Geriatric (n=393) Cognitive Impairment 33% 30% 61% Depression 33% 34% 41% Anxiety 29% 30% 29%

9 Demographics Cognitively Impaired Not Cognitively Impaired Total (n=250) Median Age (IQR) 86 (80-90) 79 (75-84) 84 (79-89) Residence: Alone 39% 75% 47% With another 33% 25% 31% Care Home 27% 0% 21%

10 Mental Health Problems Mental Health Problems Total n=250 Cognitive Impairment 79% Depression 52% Delirium 43% Diagnosed dementia 43%

11 Mental Health Problems Mini Mental Scores Total n=250 Estimated prevalence for over 70 s % 20% % 13% % 17% % 50%

12 Functional Problems Cognitive Impairment No Cognitive Impairment Total n=250 Incontinence 53% 23% 47% Help with Feeding 58% 13% 49% Supervised walking 38% 25% 35% Risk of Malnutrition 85% 63% 80%

13 Behavioural and Psychological Problems Cognitive Impairment No Cognitive Impairment Total n=250 Delusions 14% 6% 12% Hallucinations 10% 8% 10% Agitation/ Aggression 17% 2% 14% Apathy 38% 15% 33% Motor Behaviour 21% 4% 17%

14 28 Bed Healthcare of the Elderly Ward Cognitive Impairment

15 28 Bed Healthcare of the Elderly Ward Cognitive Impairment 17

16 28 Bed Healthcare of the Elderly Ward Cognitive Impairment Supervision needed when walking

17 28 Bed Healthcare of the Elderly Ward Cognitive Impairment Supervision needed when walking 7

18 28 Bed Healthcare of the Elderly Ward Cognitive Impairment Supervision needed when walking Motor Behaviour

19 28 Bed Healthcare of the Elderly Ward Cognitive Impairment Supervision needed when walking 2 Motor Behaviour

20 28 Bed Healthcare of the Elderly Ward Cognitive Impairment Supervision needed when walking Motor Agitation/ Behaviour Aggression

21 28 Bed Healthcare of the Elderly Ward Cognitive Impairment Supervision needed when walking 1 Motor Agitation/ Behaviour Aggression

22 28 Bed Healthcare of the Elderly Ward Cognitive Impairment 17

23 28 Bed Healthcare of the Elderly Ward Cognitive Impairment Malnutrition Risk 14

24 28 Bed Healthcare of the Elderly Ward Cognitive Impairment Malnutrition Risk 10 Help with Feeding

25 28 Bed Healthcare of the Elderly Ward Cognitive Impairment 6 Malnutrition Apathy Risk Help with Feeding

26 Implications for Clinical Practice

27 Implications for Clinical Practice Mental health problems are common amongst older patients in the general hospital

28 Implications for Clinical Practice Mental health problems are common amongst older patients in the general hospital The combination of mental health problems with functional, behavioural and psychiatric problems makes the task of care delivery difficult.

29 Implications for Clinical Practice Mental health problems are common amongst older patients in the general hospital The combination of mental health problems with functional, behavioural and psychiatric problems makes the task of care delivery difficult. Additional staffing and skills are needed to adequately care for these patients

30 Conclusion We need to develop and evaluate services which optimise the detection and management of mental health problems in older people.

31 Medical and Mental Health Unit Higher staffing ratio Mental Health Expertise Person centred care training Environmental changes Activities

32 Thank you Any Questions?

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