The increasing numbers of people with dementia in the UK, as well as the associated costs have led to an effort to improve dementia services for the benefit of patients, caregivers and the taxpayer. These efforts have frequently emphasised the importance of early diagnosis in dementia care. We sought to test the hypotheses that the mean cognitive score of new referrals to a secondary care memory assessment service increased while mean age decreased over a period of 20 years. We retrospectively analysed the data of 1476 patients. The passage of time was associated with a significant increase in mean cognitive scores, while there was no association between time and age after controlling for other factors. We suggest that memory services need to be designed to meet the needs of less cognitively impaired patients. In practice this means that using simple screening tests is not sufficient in this group of patients.

<p>The Mental Capacity Act 2005 (MCA) guides clinicians in England and Wales in how to support patients to make a capacitous decision. Documentation of patients’ capacity is mandatory for certain decisions in psychiatric hospitals so as to evidence the use of the MCA guidance. Given the importance of decisions such as where to live and what medication to take, the quality of clinician interview and documentation is important to monitor.</p><p><br />Method: The quality and quantity of decision-making capacity (DMC) documentation was reviewed in a psychiatric hospital in England for older adults. The clinical records of 49 discharged patients were examined retrospectively. All DMC documentation found was compared with existing legal guidance on capacity assessment.</p><p><br />Results: 46/58 DMC documents were found to be insufficient. There was little evidence of what information had been given to patients to enable autonomous decision making, what actions had been undertaken to optimise capacity and what alternative decision options were presented.</p><p><br />Conclusions: Consideration should be given by hospital managers to support DMC assessment by staff. Further reflection is needed on the part of regulators regarding the optimum DMC documentation standard, particularly regarding physical health medication for psychiatric inpatients. Guidance and training for all staff involved in the assessment and documentation of DMC should be made available.</p>

AimsThis project aims to examine a group of service users over the age of 65 with functional presentations, who were assessed by the Liaison Psychiatry team between June 2018 and 2019.Hypotheis: We believe that there is a need for a community crisis service for the older adult North Derbyshire population with functional presentations.BackgroundDue to the lack of community crisis services for patients over 70, it was felt that a significant number of these patients were admitted to inpatient psychiatric units from medical wards who would benefit from crisis intervention instead. We wanted to see the clinical outcomes of this population, referred to the liaison team, determining whether this was significant concern. If this need is established, based on the data collected, this will enable the trust to look into starting a service for this age group to provide care in their own home. In turn, it will help to reduce unnecessary admissions to acute mental health wards and reduce stays in the general hospital – preventing consequences associated with long term hospital stays.MethodRetrospective analysis using PARIS notes of 366 patients referred to the liaison team were scrutinised to determine the assessment diagnosis and outcome of patients with functional conditions. The inclusion criteria were patients over the age of 65 referred with functional psychiatric illnesses between June 2018 and 2019. We excluded 84 patients assessed to have delirium or organic presentations from our analysis. Data were collected and analysed using Excel.ResultAmong the referrals to the liaison team, the majority of patients were referred with mood disorders followed by self-harm, psychosis and anxiety. Although the majority of patients were referred back to either the community mental health team or primary care, 11% of the sample were admitted to inpatient psychiatric units. This number may have been lower and admission may have been avoided if a community crisis service was in place for this population.ConclusionIn conclusion, the data support our initial concerns that there is a need for crisis services for this age group with functional presentations. There is ongoing discussions around a need to develop this service and therefore our results will contribute to the development of an older adult functional service in Derbyshire.

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AimsAlcohol-related brain damage (ARBD) is used to describe a variety of clinical syndromes associated with excessive intake of alcohol. It can present with cognitive and neurological syndromes, including Wernicke's encephalopathy, Korsakoff's syndrome, alcohol dementia, cerebellar atrophy and frontal lobe dysfunction, Central pontine myelinolysis and Marchiafava Bignami disease. In up to 25% of cases ARBD can be complicated by traumatic head injury and brain blood supply disturbances. In the absence of clear national guidelines, standards or established pathways of care across most of the UK, most patients are unable to access appropriate service provision. The North Derbyshire mental health liaison team (MHLT) provides assessment and diagnosis of acute alcohol related brain injury, assess severity (based on clinical presentation, investigation findings, cognitive assessment) and provide a care plan with follow-up to various community services. Aim and objectives: To find out the discharge outcome for patients with ARBD diagnosis by the north MHLT, help us identify service gaps and look at ways to improve patient's care in this group.MethodsWe retrospectively analysed 300 patients who were referred to liaison team for drug and alcohol problems and were seen by the drug and alcohol lead nurse within the liaison team. Patients who were given a diagnosis of ARBD by the liaison team were included in the study.We looked at 1.Age and gender distribution2.Team who gave the initial diagnosis3.Discharge destination4.Community follow-up and engagementResultsWe identified 17 patients who were given diagnosis of ARBD. There was relatively equal distribution of male to female patients. Majority of diagnosis’ were given by liaison team. The discharge destination was variable with around half referred to ARBD rehabilitation unit and Derbyshire recovery partnership. Engagement was poor with only 20% of patients engaging with services.ConclusionRecommendations: 1.Detailed cognitive tests need doing for screening and to establish severity2. Consideration for which neuroimaging modalities can help aid diagnosis, if any, should be made. 3.ARBD leaflets to be given4.ARBD diagnosed patients who do not need rehabilitation unit, should be referred for social care assessment as an inpatient and / or be followed up in the community under Care Act5. Considerations with the Multi Disciplinary Team for ways to improve engagement in the community, perhaps with more frequent and robust follow-ups.