Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65.

INTRODUCTION: The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number and type referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult. METHODS: We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. We described trends in the number, rate, age, mental health presentation, and time taken to assessment over a 7 years period. RESULTS: Referral data from 28 EDs across England and Scotland were analysed (n = 18,828 referrals). There was a general trend towards increasing numbers of people referred to liaison psychiatry year on year. Variability in referral numbers between different departments, ranged from 0.1 to 24.3 per 1000 ED attendances. The most common reasons for referral were mood disorders, self-harm and suicidal ideas. The majority of referrals were assessed within 60 min, however there is variability between departments, some recording waits over 11 h. DISCUSSION: The data suggests great inter-departmental variability in referral numbers. Is not possible to establish the cause of variability. However, the data highlights the importance of asking further questions about why the differences exist, and the impact that has on patient care.

The utility of EEG in dementia: a clinical perspective.

BACKGROUND: Despite being simple and cheap, the EEG is not often used in clinical practice. METHODOLOGY: Literature search using PUBMED and Medline. RESULTS: Quantitative EEG can help to identify mild dementia and mild cognitive impairment and can increase diagnostic accuracy when used with other imaging techniques. EEG helps differentiate organic from functional brain disease and predict response to cholinesterase inhibitors and is central in the diagnosis of Creutzfeldt Jacob disease. The accuracy of EEG may be greater than that of CT or MRI scans alone. DISCUSSION: Quantitative EEG may save on specialist interpretation time and enable more routine use of EEG in diagnosis and care. More widespread use of EEG's is indicated. Agreement on the parameters that are best measured on qEEG is still awaited.

Dementia and use of psychotropic medication in non-'Elderly Mentally Infirm' nursing homes in South East England.

BACKGROUND: There is concern about inappropriate use of psychotropic medication in nursing homes in the UK. Older people with advanced dementia, who might need such medication, are supposed to be admitted to specialist 'Elderly Mentally Infirm' homes. OBJECTIVES: To estimate the prevalence of dementia and psychotropic medication use in UK non-Elderly Mentally Infirm homes. DESIGN: a) Probability sample of non-elderly mentally infirm places in nursing-homes in South-East England then b) two-stage survey of a probability sample of residents in these places SETTING: Non-Elderly Mentally Infirm nursing homes for older people in SE England. SUBJECTS: Residents registered non-Elderly Mentally Infirm homes. METHODS: Assessment using mini mental state examination for cognitive impairment, the Behave-AD for behavioural problems and the Cornell Scale for depression. Mini mental state examination scores were validated against independent psychiatric assessment in a sub-sample of residents. We gathered medication data from prescription sheets. RESULTS: Of the 445 residents 74% assessed had probable clinical dementia. Of all the residents 38% had severe cognitive impairment, with a three-fold higher rate of behavioural disturbance than others. Psychotropic medication was strongly associated with cognitive impairment. Antipsychotic drugs were prescribed for only 15% of all residents. CONCLUSIONS: If nearly three-quarters of non-Elderly Mentally Infirm nursing home residents have dementia, many with behavioural disturbance, then dementia care is not a 'specialist' area of nursing home care. This study offers no support for the hypothesis that use of antipsychotic drugs in nursing homes is excessive. Questions are raised about policy, staffing and training in nursing homes.