Does standardized needs assessment improve the outcome of psychiatric day hospital care for older people? A randomized controlled trial.

There is little evidence to indicate how far psychiatric day hospitals for older people can identify and address the needs of older people who attend. The current practice of Care Programme Approach (CPA) in which multidisciplinary team members, patients and their families meet, may provide a suitable forum for needs to be discussed and interventions planned and implemented. One hundred and twelve new day hospital patients over a period of one year were randomly allocated to an experimental group in which the Camberwell Assessment of Need for the Elderly (CANE). Assessment reports were fed back to day hospital staff but not to the control group in which routine practice was maintained. Similar follow-up assessments were performed after three months in the day hospital or at the time of discharge. At follow-up, both the experimental and control groups had over 60% of their initial unmet needs being adequately met. In both groups, the Health of the Nation Outcome Scales 65+ scores and number of unmet needs were reduced indicating an improvement for both groups. However, there were no significant differences in outcome at follow-up between the experimental and control groups. Day hospitals for older people with mental health problems appear effective in identifying and meeting needs. The feedback from CANE made no difference in terms of outcome.

Social networks and health of older people living in sheltered housing.

Eighty-seven residents from three sheltered accommodation schemes for people over 60 years, were interviewed about: their physical and mental health, social networks, social support, decision to move in, and how they found living in sheltered housing. Twenty-four percent had a diagnosis of depression and 8% dementia, but few had ever seen a mental health professional. Over half (55%) had clinically significant levels of activity limitation and 37% had significant somatic symptoms. Despite provision of glasses or aids 31% could not see satisfactorily and 23% could not hear adequately. Locally integrated social networks were most common (41%). Residents with a private network (16%) were more likely than those with a locally integrated network to have significant activity limitation and to report often being lonely. There were no differences between network types in levels of depression or dementia. Poor health of a person or their spouse was the most commonly reported reason for moving to sheltered housing, followed by the possibly related reasons of problems with their old home no longer being suitable e.g. stairs, and because they wanted to have a warden or alarm system available should the need arise. Most residents were happy living in sheltered accommodation. Many made use of 'sheltered' features such as the common room, the communal laundry, the warden and the alarm. A minority of residents were lonely and a few were unhappy with sheltered accommodation.

The Psychiatric Care Satisfaction Questionnaire: a reliability and validity study.

Patient satisfaction can be a useful marker in evaluating the quality of psychiatric care. However, this form of measurement has been hampered by the lack of attention paid to the psychometric properties of instruments devised. The Psychiatric Care Satisfaction Questionnaire (PCSQ) was developed and tests of acceptability, validity and reliability were undertaken using 52 inpatients. Content validity was assessed by surveying psychiatrists, other mental health professionals, MIND workers and patient groups. Thirty-six (67.9%) of all mental health professionals felt that the questionnaire was a useful measure of patients' satisfaction with their care, and many comments also suggested high consensual validity. In terms of content validity, responses from patient groups indicated that the majority (63.6%) felt it to be a useful measure of patient satisfaction and 70.5% felt all the areas covered were important. Concurrent and criterion validity were also good, with high correlations with existing scales and with those on a section being significantly less satisfied on the PCSQ (F = 13.3, P = 0.0004). Test-retest reliability was adequate (Cohen's kappa 0.48-0.80) and the internal consistency of the PCSQ was good, at 0.82 (Cronbach's alpha). The PCSQ performed well in all aspects of validity and reliability, indicating that it has good psychometric properties and can be a useful tool for measuring patient satisfaction. However, there remains the need to analyse more closely the concept of satisfaction and its determinants.

Management of depression in the elderly by general practitioners: referral for psychological treatments.

This study investigates referrals for psychological therapies in general practitioners (GPs) from five catchment areas. The results show that 93 per cent of GPs would consider referring elderly patients for psychological help but only 44 per cent had done so and one in three GPs were unfamiliar with the psychological therapies available. When GPs were asked to select a psychological treatment for depression, 60 per cent chose counselling compared to 21 per cent who chose cognitive-behavioural therapy (CBT). Female GPs particularly favoured counselling. Experience in psychiatry was associated with selection of CBT. The results show that GP training and further education should emphasize psychological therapies. This should make referrals more appropriate and improve patient care.

Patients' views towards care received from psychiatrists.

BACKGROUND: Measurement of the quality of psychiatric care including assessment of patients' views have become increasingly important as expectations of the standard of care rises. METHODS: Attitudes and satisfaction of acute psychiatric in-patients were investigated using a questionnaire looking at satisfaction, patients' views on personal and professional qualities of psychiatrists, empowerment and insight. RESULTS: The response rate was 79.2% (137 out of 173). Patients with a diagnosis of a non-affective psychotic illness, particularly those lacking insight were significantly less satisfied with their care. Respondents were more satisfied with the personal rather than the professional qualities of the doctors, and less satisfied with their empowerment and doctors' availability. CONCLUSIONS: In-patients' attitudes towards their psychiatric care involves a complex relationship between clinical and sociocultural characteristics. Satisfaction studies can serve as an important monitor and reminder of patient dissent.

Life events: the reliability of rating changes in routine and environment.

Alterations in routine and environment can affect clinical state in patients suffering from cognitive impairment. A method for rating life events for changes in routine and environment is described and found to be highly reliable even when used by inexperienced raters after brief training.

Self-neglect and frontal lobe dysfunction.

An elderly lady, of superior verbal intelligence and with no severe psychiatric condition, severely neglected herself, and required prolonged day patient care. Brain scans showed selective frontal atrophy, and both traditional and new computerised neuropsychological testing demonstrated severe frontal dysfunction.