scholarly journals Lithium monitoring in patients over 65 in NHS Greater Glasgow and Clyde

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S32-S32
Author(s):  
Catriona Ingram ◽  
Karli Dempsey ◽  
Gillian Scott ◽  
Joe Sharkey
Keyword(s):  
Old Age ◽  
Catchment Area ◽  
Current Practice ◽  
High Variability ◽  
Health Board ◽  
Data Set ◽  
Number Of Patients ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
Plasma Monitoring

AimsOur aim was to identify current practice for Lithium monitoring for >65s in NHS GGC and assess compliance to local Lithium monitoring guidelines.MethodA retrospective analysis was undertaken of patient data (demographics, diagnosis, biochemistry results) with Caldicott approval at two points over the course of 2018/19. For the first analysis, old age Community Mental Health Teams (CMHTs) were approached and asked to provide a list of their patients on Lithium. This was then assessed for compliance to Lithium monitoring guidelines.For the second analysis, pharmacy provided data for every patient in the health board dispensed lithium, regardless of whether they were open to a CMHT or not. We were then able to identify patients who we had not picked up on our initial analysis, and re-assess the entire data set for compliance to Lithium monitoring guidelines.ResultFrom our first analysis, 13 CMHTs identified 155 patients on Lithium. There was a high variability in how these patients were identified. 44% of patients were monitored by CMHTs who took bloods and chased them, 38% were monitored by GPs who were prompted by CMHTs in routine clinic letters, and 14% were monitored by GPs who were prompted by CMHTs more assertively using a lithium register. Overall, Lithium plasma monitoring was done well irrespective of method (91%), however compliance to the local standards was poor (58%) with proactive CMHT prompting GPs appearing to be the most effective method (71%).In our second analysis, we identified 508 patients >65 in NHS GGC prescribed Lithium. Of those, 44% were open to old age psychiatry, 25% general adult psychiatry and 19% were not open to anyone. Of those open to old age services, only 58% had been identified in the previous audit. Lithium monitoring compliance was better in those open to a CMHT versus those not (61% to 23%), and better in CMHTs where monitoring was done by CMHTs rather than GPs. For each CMHT, there were roughly 7 patients per catchment area on Lithium not open to psychiatry.ConclusionLithium monitoring does appear to be highly variable and not particularly compliant with local standards. CMHTs have inconsistent methods of identifying patients prescribed Lithium. There are a significant number of patients not open to old age CMHTs prescribed Lithium, and these patients have poorer compliance to Lithium monitoring. Of patients open to CMHTs, CMHT-led monitoring appears superior to other forms.

Older people with enduring or recurrent severe mental illness in the Eastern Region of Ireland

2006 ◽  
Vol 23 (4) ◽  
pp. 145-150 ◽  
Author(s):  
Margo Wrigley ◽  
Bernadette Murphy ◽  
Martin Farrell ◽  
Brendan Cassidy ◽  
Jim Ryan
Keyword(s):  
Mental Illness ◽  
Older People ◽  
Severe Mental Illness ◽  
Old Age ◽  
Eastern Region ◽  
Service Utilisation ◽  
Number Of Patients ◽  
Adult Psychiatry ◽  
Comprehensive Survey ◽  
Old Age Psychiatry

AbstractObjectives: There has been no specific planning for older people with enduring or recurrent severe mental illness in Ireland. This survey aims to identify the number of affected over 65 year olds (graduates) and 55-64 year olds (prospective graduates) in the Health Service Executive, Eastern Region, their diagnoses and their use of psychiatric services.Method: A comprehensive survey of the ten general adult psychiatry and four old age psychiatry services in the (HSE) Eastern Region was undertaken for the year 2003 to determine the number of patients, their diagnoses and service utilisation.Results: 649 people over 65 years old were identified within the general adult psychiatry services and a further 279 within the old age psychiatry services giving a total of 928. (This number rose to 1141 after correcting for missing outpatient data.) 1,397 people between the ages of 55-64 were identified. (This number rose to 1,916 after correcting for missing outpatient data.)Conclusions: There are substantial numbers of ‘graduates’ and ‘prospective graduates’ in the Eastern Region. It is essential that services for this population are specifically planned for and further qualitative research is required to inform this process.

scholarly journals A new opportunity: three tales of training in liaison psychiatry of old age

2002 ◽  
Vol 26 (11) ◽  
pp. 433-435 ◽  
Author(s):  
John Holmes ◽  
Jon Millard ◽  
Susie Waddingham
Keyword(s):  
General Hospital ◽  
Old Age ◽  
Psychiatric Comorbidity ◽  
Psychiatric Symptoms ◽  
Specialist Training ◽  
Liaison Psychiatry ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
Hospital Wards ◽  
And Training

Liaison psychiatry has emerged as a sub-speciality within general adult psychiatry, with specific experience and training being required to develop the skills and knowledge to address comorbid physical and psychiatric symptoms and illness (House & Creed, 1993; Lloyd, 2001). Older people often present with significant physical and psychiatric comorbidity (Ames et al, 1994; Holmes & House, 2000) and most old age psychiatry services receive one-quarter to one-third of referrals from general hospital wards (Anderson & Philpott, 1991). Despite this, there are no specific requirements for training in liaison psychiatry for old age psychiatrists at any level. The experience gained in assessing and treating general hospital referrals during basic and higher specialist training is felt to be adequate (Royal College of Psychiatrists, 1998).

scholarly journals An audit: fitness to drive assessment in inpatients of general adult and old age psychiatry

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S200-S201
Author(s):  
Ismail Khan ◽  
Nneamaka Asiodu ◽  
Dr Divyanish ◽  
Anum Yaqoob ◽  
Hasanain Qureshi
Keyword(s):  
Old Age ◽  
Social Withdrawal ◽  
Data Collection Tool ◽  
Fitness To Drive ◽  
Good Medical Practice ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
Duty To Inform ◽  
The Impact ◽  
Physical Health Screening

AimsTo determine if fitness to drive is assessed on admission and discharge, if applicable, and for this to be documented during clerking and on discharge notifications.To determine if patients are being educated about the impact of their condition on the ability to safely drive.To ascertain if patients are aware of the duty to inform the DVLA if they for any reason are not fit to drive.BackgroundRisk factors include social, behavior and iatrogenic factors such as social withdrawal, increased likelihood of substance abuse and side effects of anti-psychotic medication.MethodThis trust wide audit involved the random sampling of a total of 71 case notes, 4 case notes per Consultant team in general adult psychiatry and old age psychiatry across Dudley and Walsall sites (total of 3 sites). A data collection tool was developed and included relevant questions regarding fitness to drive. Data were collected between October and December 2019.Result18/49 patients had physical health screening prior to medication initiation.ConclusionAn important aspect of good medical practice is to educate patients about their condition, this includes their fitness to drive as this can be affected both by their diagnosis and medication. It is clear that clinicians also need to be educated about this responsibility to ensure assessment is performed especially on inpatient discharge.

scholarly journals A brief computerised discharge summary in old age psychiatry: general practitioner reactions

1990 ◽  
Vol 14 (6) ◽  
pp. 330-330 ◽  
Author(s):  
J. P. Wattis ◽  
David Protheroe
Keyword(s):  
General Practitioner ◽  
Old Age ◽  
Catchment Area ◽  
Discharge Summary ◽  
Medical Audit ◽  
Other Information ◽  
Old Age Psychiatry ◽  
Surgical Audit

In an attempt to provide data for medical audit, to standardise the information on discharge letters and to speed communication, a computerised discharge form was introduced for a catchment area of 20,000 people over 65 years. The programme, based on a surgical audit programme using DBASE II, was developed by one of us to run on an Amstrad PCW. This produced a discharge summary on a standard layout which gave the date of admission, the patient's name, date of birth and address as well as the consultant and GP's name. The patient's diagnosis (according to ICD-9), and a list of disciplines and facilities involved in follow-up preceded brief notes on history and progress. Date of discharge was followed by a list of medication and a space for ‘other information’. All this was contained on one side of A4 paper.

scholarly journals Fear of flying, reviewed: An example of evidence-based old age psychiatry

2002 ◽  
Vol 26 (5) ◽  
pp. 188-190 ◽  
Author(s):  
Gianetta Rands
Keyword(s):  
Clinical Practice ◽  
Old Age ◽  
Evidence Based ◽  
Significant Deterioration ◽  
Fear Of Flying ◽  
Number Of Patients ◽  
The Family ◽  
Old Age Psychiatry ◽  
Person With Dementia ◽  
Patients Experience

‘Doctor, would it be alright to take mum to Cyprus for a family wedding?’ In a cosmopolitan city such as London hardly a month goes by without hearing a similar sort of query. If ‘mum’ has dementia I tend to advise the family against flying. This advice is based on anecdotal observations from past clinical practice. I have witnessed a number of patients experience significant deterioration in cognition following flying. While disorientation in unfamiliar environments may explain some of the difficulties in travelling for a person with dementia, as illustrated by John Bayley in Iris (1998), this may not be the only explanation. On this occasion, I decided to use evidence-based practice to review the situation.

scholarly journals The service user voice in shaping mental health policy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Cachia
Keyword(s):  
Mental Health ◽  
Civil Society ◽  
Old Age ◽  
Service User ◽  
Hospital Setting ◽  
Primary Health Care System ◽  
Health Strategy ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
Acute Psychiatric Care

Abstract Background Over the last 7 years CMH Malta provided holistic evidence for a mental health strategic framework with the regular input of patients, families, NGOs and civil society. Methods This evidence featured in published Annual Reports, conference presentations, bilateral meetings, and media interventions. The National Mental Health Strategy 2020-2030 was published in July 2019. CMH proffered advice, experience and supporting documents to the Strategy Team. 80% of the action points in the strategy reflect CMH recommendations. Results The philosophy of care should emphasise person-centred multi-disciplinary care. The primary health care system must be an effective gatekeeper providing mental health promotion and care in the community thus preventing hospital admissions. Acute psychiatric care must be provided within the acute general hospital setting with active support of A&E and 24/7 intervention services that deal promptly with emergencies. Transition of youngsters to adult psychiatry and of adults to old age psychiatry should be flexible. Community-based rehabilitation is required for Adult Psychiatry, Child/Adolescent/Youth Psychiatry, Old Age Psychiatry, Forensic Psychiatry and Learning Disability. Policymakers must provide care options for older persons with chronic mental disorders, safe settings for youngsters with severely challenging behaviour, and shelters for persons suffering from substance misuse who resist treatment or rehabilitation. Conclusions Implementation of the Mental Health Strategy requires substantial capital investment and new resources. Service re-engineering and synergy are necessary to avoid duplication and waste. Better complements of professionals must be available to provide alternative therapies to the current medical pharmacological model. Key messages Patients, families, NGOs and civil society are critical partners in strategy development. Action points and implementation plans must reflect service user views and advice.

scholarly journals Hospital Anticipatory Care Planning for Inpatients of Organic Old Age Psychiatry Wards (NHS Lanarkshire)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S176-S177
Author(s):  
Sarah Brennan ◽  
Rajdeep Routh
Keyword(s):  
Old Age ◽  
Good Practice ◽  
Health Board ◽  
List Type ◽  
Care Planning ◽  
Care Plans ◽  
Information Leaflets ◽  
Medical Emergencies ◽  
Old Age Psychiatry ◽  
Treatment Escalation

AimsTo improve practice of Hospital Anticipatory Care Planning for inpatients of Organic Old Age Psychiatry wards in NHS Lanarkshire.BackgroundHospital Anticipatory Care Plans (HACPs) are important components of care for inpatients with progressive and life-limiting conditions. HACPs provide guidance on treatment escalation and limitation for individual patients, in the event that they become acutely unwell. In the Old Age Psychiatry Department at NHS Lanarkshire, HACP standards are as follows: HACP forms should be completed within 2 weeks of admissionHACP information leaflets should be provided to relatives/carersHACPs should be discussed with relatives/carersIf a patient without an HACP becomes acutely unwell, an HACP should be made, and the responsible Consultant informedHACP should be discussed within the multi-disciplinary team (MDT)HACPs should be regularly reviewedHACP and DNACPR forms should be kept at the front of the notesSuperseded HACPs should be marked as obsoleteMethodInpatient notes were reviewed in October 2019 and compared against the above standards.The findings were presented at the Clinical Governance Meeting and Old Age Psychiatry Teaching Group in December 2019.An ‘HACP Checklist’ was also created to prompt good practice.Inpatient notes were reviewed again in July 2020.Data from both time periods were compared.ResultThere was an improvement in:The proportion of patients who had an HACP - from 59% to 96%The proportion of patients who had an HACP made within 2 weeks of admission - from 35% to 78%Documentation of HACP discussions with relatives/carers - documented for 77% of patients (from 47%)Timing of HACP discussions with relatives/carers - took place within 2 weeks for 52% of patients (from 29%)Documentation of HACP discussion by MDT - documented for 73% of patients (from 29%)HACP Information Leaflets were only distributed to one patient's relatives/carers across both time pointsMedical emergencies for patients with no HACP were infrequent and so comparison could not be madeHACPs were reviewed less frequently in July 2020 than in October 2019HACP forms and DNACPR forms were always filed appropriatelySuperseded HACP forms were always appropriately marked as obsoleteConclusionHACP practice mostly improved from October 2019 to July 2020. This may have been due to increased awareness of HACP Standards, following the presentation of initial data to inpatient teams.A much larger influence, however, was likely to be the COVID-19 pandemic and associated efforts to improve HACP practice throughout the Health Board.

scholarly journals General adult and old age psychiatry specialist registrar training – crisis looming?

2003 ◽  
Vol 27 (04) ◽  
pp. 152-154
Author(s):  
Denise Cope
Keyword(s):  
Old Age ◽  
Training Programme ◽  
Postal Questionnaire ◽  
Psychiatric Training ◽  
Specialist Registrar ◽  
Training Scheme ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
National Training ◽  
Registrar Training

Aims and Methods A postal questionnaire was sent to 31 Specialist Registrar Training Programme Directors in general adult and old age psychiatry in England, Scotland and Wales to ascertain the recruitment position on their training scheme and their views on recruitment. Results There was no recruitment to 24% of specialist registrar (SpR) posts. A 17% increase in national training numbers in general adult and old age psychiatry had occurred in the schemes surveyed during the past 2 years. An insufficient number of senior house officer (SHO) posts was identified by 42% of respondents and the unattractiveness of general adult psychiatry recorded by 58% of respondents as factors in under-recruitment. Implications Under-recruitment at consultant level in general adult and old age psychiatry is being replicated at specialist registrar level. Trainees are not being encouraged into higher psychiatric training by increasing specialist registrar national training numbers. Insufficient SHO posts and the perceived unattractiveness of general adult psychiatry appear as significant factors contributing to poor recruitment at SpR level.

scholarly journals General adult and old age psychiatry specialist registrar training – crisis looming?

2003 ◽  
Vol 27 (4) ◽  
pp. 152-154 ◽  
Author(s):  
Denise Cope
Keyword(s):  
Old Age ◽  
Training Programme ◽  
Postal Questionnaire ◽  
Psychiatric Training ◽  
Specialist Registrar ◽  
Training Scheme ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
National Training ◽  
Registrar Training

Aims and MethodsA postal questionnaire was sent to 31 Specialist Registrar Training Programme Directors in general adult and old age psychiatry in England, Scotland and Wales to ascertain the recruitment position on their training scheme and their views on recruitment.ResultsThere was no recruitment to 24% of specialist registrar (SpR) posts. A 17% increase in national training numbers in general adult and old age psychiatry had occurred in the schemes surveyed during the past 2 years. An insufficient number of senior house officer (SHO) posts was identified by 42% of respondents and the unattractiveness of general adult psychiatry recorded by 58% of respondents as factors in under-recruitment.ImplicationsUnder-recruitment at consultant level in general adult and old age psychiatry is being replicated at specialist registrar level. Trainees are not being encouraged into higher psychiatric training by increasing specialist registrar national training numbers. Insufficient SHO posts and the perceived unattractiveness of general adult psychiatry appear as significant factors contributing to poor recruitment at SpR level.

scholarly journals Information and advice received by carers of younger people with dementia

1999 ◽  
Vol 23 (2) ◽  
pp. 94-96 ◽  
Author(s):  
Hilary J. Husband ◽  
Meera N. Shah
Keyword(s):  
Social Services ◽  
Old Age ◽  
Comparison Group ◽  
Structured Interview ◽  
Clinical Implications ◽  
Advice Giving ◽  
Lack Of Information ◽  
People With Dementia ◽  
Adult Psychiatry ◽  
Old Age Psychiatry

Aims and methodRetrospective information on advice and information received post-diagnosis was obtained from 40 carers of younger people with dementia, using a semi-structured interview.ResultsTwelve carers received services from old age psychiatry, the remaining 28 from predominantly adult psychiatry or neurology. Those in receipt of old age services reported greater adequacy of diagnostic information, higher levels of advice giving and more frequent referral to social services.Clinical implicationsWhile old age services were more successful on the parameters examined, the gradually emergent nature of the diagnosis may be a crucial factor in the lack of information and advice received by the comparison group.

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