Liaison old age psychiatry

Abstract

Older people are commonly encountered in general hospital settings, where they occupy two-thirds of all beds. There are high levels of psychiatric comorbidity in this population, with depression, dementia and delirium being particularly common. This psychiatric comorbidity results in poor outcomes for patients, carers and services alike. Traditionally, old age psychiatry input has been on a consultation basis, relying on general ward staff to detect problems and refer appropriately. This does not always work well, since general hospital staff often lack the necessary knowledge and skills to detect and manage psychiatric illness correctly, and this in turn contributes to the observed poor outcomes. In recognition of this, some areas have developed specialist old age liaison psychiatry services delivered by general hospital-based mental health professionals. These liaison services are able to respond more quickly to referrals than the traditional service model. Staff working in these services are able to develop specialist skills relevant to the psychiatric conditions found in general hospitals, thus improving the quality of the psychiatric input. More importantly, liaison staff spend time educating and training their general hospital colleagues to improve the core knowledge and skills, including better detection of psychiatric conditions, better delivery of basic care and recognition of the time to call for specialist psychiatric help. Although the evidence base for the efficacy and effectiveness of these services is limited, there is a groundswell of opinion that they are necessary to improve the care of older people with psychiatric problems on general hospital wards.