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Outcome measures for old age liaison psychiatry
- Paul J Whelan, Kirsten Lawson, Specialist Registrar in Old Age Psychiatry Kent and Medway NHS and Social Care Partnership Trust (18 August 2008)
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Paul J Whelan, Locum Consultant Old Age Psychiatrist South London and Maudsley NHS Foundation Trust, Kirsten Lawson, Specialist Registrar in Old Age Psychiatry Kent and Medway NHS and Social Care Partnership Trust
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pwhelan{at}gotadsl.co.uk Paul J Whelan, et al.
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Anderson et al.’s (2008) study contributes to a number of good quality evaluations of old age liaison services in the UK that now exist in the literature (Mujic et al., 2004, Whelan et al., 2007). Old age liaison services have become increasingly popular because, amongst other reasons, it is believed they reduce admission lengths for diagnostic conditions traditionally associated with ‘bed blocking’, namely dementia and delirium. In our evaluation of the Lewisham Older Adults Consultation and Liaison (LOACaL) Service it was interesting that whilst all other parameters improved (‘time- to-see’, advice given being acted upon etc.) admission lengths were actually increased (Whelan et al., 2007). We attributed this to the fact that we championed the needs of the clients we saw and ensured that, where a care home placement was required, the older person was placed in the most appropriate – rather than the most easily found – place of residence. We applaud the work done by Anderson et al., however, in an era of Payments by Results we are arguably at a stage where we need to move on from studies evaluating simple parameters, such as geriatricians acting on advice given. It seems likely that HoNOS-Plus will be the instrument used within this payment model. On further evaluation of the LOACaL Service, paired HoNOS 65+ scores were collected at referral and discharge and showed a statistical significant improvement (Lawson et al.). This is important because the few clinical trials that exist in the field have failed to show substantial improvements for older adult medical inpatients with mental health problems (Baldwin et al. 2004, Cullum et al., 2007). Liaison psychiatry, for a number of reasons, does not lend itself well to experimental research. However, HoNOS is an outcome – not a research – measure and is well suited to service evaluation. We need to think long and hard about what we are trying to prove in the subspeciality and how we are going to do it. References: ANDERSON, D., CATTELL, H. & BENTLEY, E. (2008) Nurse-led liaison psychiatry service for older adults: service evaluation. Psychiatr Bull, 32, 298- 302. BALDWIN, R., PRATT, H., GORING, H., MARRIOTT, A. & ROBERTS, C. (2004) Does a nurse-led mental health liaison service for older people reduce psychiatric morbidity in acute general medical wards? A randomised controlled trial. Age Ageing, 33, 472-48. CULLUM, S., TUCKER, S., TODD, C. & BRAYNE, C. (2007) Effectiveness of liaison psychiatric nursing in older medical inpatients with depression: a randomised controlled trial. Age Ageing, 36, 436-442. LAWSON, K & BURTON, S. (unpublished) Service standard audit in a new old age liaison psychiatry service. Available from authors upon request. MUJIC, F., HANLON, C., SULLIVAN, D., WATERS, G. & PRINCE, M. (2004) Comparison of liaison psychiatry service models for older patients. Psychiatr Bull, 28, 171-173. WHELAN, P., LAWSON, K. & BURTON, S. W. (2007) Service innovation: an old age liaison psychiatry service. Psychiatr Bull, 31, 145-147. |
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