Dementia in the community: Challenges for primary care development

2002 ◽  
Vol 12 (3) ◽  
pp. 243-252 ◽  
Author(s):  
Steve Iliffe ◽  
Jill Manthorpe
Keyword(s):  
Primary Care ◽  
Older People ◽  
Old Age ◽  
National Service ◽  
Specialist Services ◽  
Quality Of Primary Care ◽  
Old Age Psychiatry ◽  
Primary Care Practitioners ◽  
Care Development

The National Service Frameworks for Older People and for Mental Health are setting standards for services in areas where problems are complex and solutions limited. Primary Care Trusts seeking to raise the quality of primary care for older people and commission specialist services rationally face many challenges. Specialists in old age medicine and old age psychiatry will find themselves working closely with primary care practitioners to develop services and extend professional skills, for it is uncertain that specialist services will be able to deal with the scale of the clinical and social problems unaided.

scholarly journals Factors affecting primary care practitioners’ alcohol-related discussions with older adults: Qualitative study

2021 ◽  
pp. BJGP.2020.1118
Author(s):  
Bethany Kate Bareham ◽  
Jemma Stewart ◽  
Eileen Kaner ◽  
Barbara Hanratty
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Older People ◽  
Focus Groups ◽  
Old Age ◽  
Later Life ◽  
Long Term Conditions ◽  
Age Related ◽  
Comparison Results ◽  
Primary Care Practitioners

Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.

Principles of service provision in old age psychiatry

2013 ◽  
Author(s):  
Tom Dening
Keyword(s):  
Older People ◽  
Social Services ◽  
Old Age ◽  
Memory Assessment ◽  
Policy Context ◽  
Effective Care ◽  
Challenges And Opportunities ◽  
Old Age Psychiatry ◽  
Fair Access

This chapter outlines the history, underlying principles and policy context for contemporary mental health services for older people. The usual components of such services, including community health teams, memory assessment services, day facilities, consultation-liaison services in general hospitals, and in-patient psychiatric care for older people are all discussed. Alongside these more familiar elements however, there have been other recent, sometimes destabilising, changes, including moves towards age-inclusive services and changes in working patterns for psychiatrists and other professionals. Working closely with primary care, greater integration with social services and providing support to care homes are all part of the current agenda. It is important to measure the quality of services and to ensure the populations who may be disadvantaged receive fair access to effective care and treatment. Obviously, the future increase in the numbers of very old people brings both challenges and opportunities for old age psychiatry services.

A survey of old age psychiatry consultation/liaison services in Ireland

2008 ◽  
Vol 25 (2) ◽  
pp. 66-68
Author(s):  
Julianne Reidy ◽  
Michael Kirby
Keyword(s):  
Public Sector ◽  
Older People ◽  
Old Age ◽  
Significant Proportion ◽  
Postal Questionnaire ◽  
Service Development ◽  
National Service ◽  
Old Age Psychiatry ◽  
The Republic

AbstractObjectives: The aim of this survey was to assess current structures for provision of consultation/liaison services to older people in the Republic of Ireland, and to ascertain the proportion of referrals to psychiatry of old age arising from consultation/liaison referrals.Methods: A postal questionnaire was sent to the 19 public sector, old age psychiatry services, operating in 2005. Information was obtained from 15 of these 19 services regarding the referrals they received in 2005.Findings: Consultation/liaison referrals make up 36% of total referrals to psychiatry of old age services. Two of 14 services had ring-fenced resources for consultation/liaison work. Three of 14 consultants described their service as having a significant liaison component. Location of the service and the criteria for accepting a referral are associated with the proportion of referrals that are consultation/liaison.Conclusions: Consultation/liaison referrals make up a significant proportion of referrals. To provide an effective consultation/liaison service ring-fenced resources are required. Despite this recent long term strategies for national service development have neglected this area.

A proactive geriatric liaison service to assess and manage medical problems on old age psychiatry wards

2016 ◽  
Vol 33 (S1) ◽  
pp. S188-S189
Author(s):  
U. Narayana ◽  
O.J. Corrado ◽  
S. Kaur
Keyword(s):  
Older People ◽  
Old Age ◽  
Quality Of Healthcare ◽  
Biliary Cirrhosis ◽  
Medical Problems ◽  
Old Age Psychiatry ◽  
Competing Interest ◽  
Outpatient Appointments ◽  
To Receive

IntroductionOlder people with mental ill health are more likely to receive lower quality of healthcare, inappropriate prescriptions and reduced access to services, leading to increased rates of mortality1,2,3. The NHS mandate 2015 to 2016 emphasises the need to deliver care, which is joined up and seamless for users of services4.Aims and objectivesTo identify the common medical comorbidities on the Old Age Psychiatry Wards and to assess the management outcomes.MethodsWe audited all patients referred to the Liaison Geriatrician from 2008 to October 2015 from the Mount Hospital Leeds, which consists of 4 Old Age Psychiatry Wards. Data was collected in October 2015 and included referral date, patients’ age and sex, number of referrals, reason for referral and the outcome.ResultsWe assessed 339 (142 F, 197 M) patients with a mean age of 77 (range: 56–94). Cardiovascular problems were the biggest group of referrals (in particular oedema, hypotension and rhythm disturbances) (34%) followed by central nervous system problems (11%), respiratory (8%), gastrointestinal (8%) and infection (8%). Some unusual problems were diagnosed including a spontaneous pneumothorax, primary biliary cirrhosis. The most common intervention was advice on treatment or investigation, very few patients needed acute admission and some unnecessary admissions were aborted as a result of the physician's intervention.ConclusionsThis audit emphasises the need for a joint coordinated approach between psychiatry and medicine in managing health problems in older people. A dedicated Geriatric Liaison service can improve care, avoid unnecessary acute admissions and is more convenient for patients who would otherwise attend repeated outpatient appointments.References are not available for this abstract.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Mania in late life

2011 ◽  
Vol 17 (5) ◽  
pp. 357-364
Author(s):  
Felicity Richards ◽  
Martin Curtice
Keyword(s):  
Older People ◽  
Old Age ◽  
Specific Treatment ◽  
Late Life ◽  
Aging Population ◽  
Age Group ◽  
Treatment Algorithms ◽  
Assessment And Treatment ◽  
Old Age Psychiatry ◽  
Older Populations

SummaryMania in late life is a serious disorder that demands specialist assessment and management. However, it is greatly under-researched, with only a paucity of studies specifically analysing older populations. The mainstay of the old age psychiatry workload will inevitably be concerned with assessing and managing dementia and depression, but the steady rise in the aging population with longer survival means that there will be an increase in absolute numbers of older people presenting with mania. There are no specific treatment algorithms available for mania in late life. This article reviews mania and hypomania in late life and concentrates on diagnosis, assessment and treatment, as well as on the management considerations associated with this important age group.

The impact of the quality of communication from nephrologists to primary care practitioners: a literature review

2014 ◽  
Vol 30 (10) ◽  
pp. 2093-2101 ◽  
Author(s):  
Moyez Jiwa ◽  
Aron Chakera ◽  
Ann Dadich ◽  
Gemma Ossolinski ◽  
Vivien Hewitt
Keyword(s):  
Primary Care ◽  
Literature Review ◽  
Primary Care Practitioners ◽  
The Impact

scholarly journals Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

2015 ◽  
Vol 17 (05) ◽  
pp. 421-427 ◽  
Author(s):  
Alexandros Maragakis ◽  
Ragavan Siddharthan ◽  
Jill RachBeisel ◽  
Cassandra Snipes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Policy Reforms ◽  
Mental Health Settings ◽  
Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

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