Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study

Abstract

BackgroundFrail older people with mental health problems including delirium, dementia and depression are often admitted to general hospitals. However, hospital admission may cause distress, and can be associated with complications. Some commentators suggest that their healthcare needs could be better met elsewhere.MethodsWe studied consecutive patients aged 70 or older admitted for emergency medical or trauma care to an 1800 bed general hospital which provided sole emergency medical and trauma services for its local population. Patients were screened for mental health problems, and those screening positive were invited to take part. 250 participants were recruited and a sub-sample of 53 patients was assessed by a geriatrician for diagnoses, impairments and disabilities, healthcare interventions and outstanding needs.ResultsMedian age was 86 years, median Mini-Mental State Examination score at admission was 16/30, and 45% had delirium. 19% lived in a care home prior to admission. All the patients were complex. A wide range of main admission diagnoses was recorded, and these were usually complicated by falls, immobility, pain, delirium, dehydration or incontinence. There was a median of six active diagnoses, and eight active problems. One quarter of problems was unexplained. A median of 13 interventions was recorded, and a median of a further four interventions suggested by the geriatrician. Those with more severe cognitive impairment had no less medical need.ConclusionsThis patient group, admitted to hospital in the United Kingdom, had numerous healthcare problems, and by implication, extensive healthcare needs. Patients with simpler conditions were not identified, but may have already been rapidly discharged or redirected to non-hospital services by the time assessments were made. To meet the needs of this group outside the hospital would need considerable investment in medical, nursing, therapy and diagnostic facilities. In the meantime, acute hospitals should adapt to deliver comprehensive geriatric assessment, and provide for their mental health needs.

A staff training intervention to improve communication between people living with dementia and health-care professionals in hospital: the VOICE mixed-methods development and evaluation study

“…However, most admissions are for legitimate medical conditions or injuries, and the delivery of necessary assessment, treatment or future care planning. 4 Caring for people living with dementia is, and will remain, an important part of what acute general hospitals do.…”

“…Such presentations are frequently complicated by falls, immobility, pain, delirium, dehydration or incontinence. 4 During a hospital admission, patients need health care to cure their acute illness, manage exacerbations of chronic conditions, relieve symptoms, restore function and prevent complications. To do this, health-care professionals carry out a range of health-care tasks or activities, such as information gathering, physical assessments, medical investigations, administering medications and physiotherapy.…”

Should I stay or should I go? How healthcare professionals close encounters with people with dementia in the acute hospital setting

“…The hospital environment can be a disorienting place for people with dementia (PWD) particularly because of unfamiliar staff, routines, and noises ( Borbasi et al., 2006 ). Acute illness with or without added delirium ( Glover et al., 2014 , Whittamore et al., 2014 ) may also exacerbate communication problems, as will hearing or visual loss associated with older age.…”

Experience of anaesthesia nurses of perioperative communication in hip fracture patients with dementia

“…Glover et al. argued that when a patient with dementia is affected by acute trauma, severe stress is experienced due to sudden psychological and physical deterioration, and it is not uncommon that patients become aggressive, paranoid and have tantrums, making the nursing situation very difficult. Anaesthesia nurses are trained that their work should be characterised by responsibility, respect and openness to the patient's state of health and that the basic contents of the intra‐operative encounter are to initiate and reinforce, as well as to complete worthy communication in order to establish the safety of the patient .…”