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This article has been cited by other articles in PMC. Abstract Background Frail sarah goldberg single people with mental health problems including delirium, dementia and depression are often admitted to general hospitals.
However, hospital admission may cause distress, and can be associated with complications. Some commentators suggest that their healthcare needs could be better met elsewhere.
Methods We studied consecutive patients aged 70 or older admitted for emergency medical or trauma care to an bed general hospital which provided sole emergency medical and trauma services for its local population. Patients were screened for mental sarah goldberg single problems, and those screening positive were invited to take part.
All the patients were complex. A wide range of main admission diagnoses was recorded, and these were usually complicated by falls, immobility, pain, delirium, dehydration or incontinence. There was a median of six active diagnoses, and eight active problems.
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One quarter of problems was unexplained. A median of 13 interventions was recorded, and a median of a further four interventions suggested by the geriatrician.
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Those with more severe cognitive impairment had no less medical need. Conclusions This patient group, admitted to hospital in the United Kingdom, had numerous healthcare problems, and by implication, extensive healthcare needs. Patients with simpler conditions sarah goldberg single not identified, but may have already been rapidly discharged or redirected to non-hospital services by the time assessments were made.
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To meet the needs of this group outside the hospital would need considerable investment in medical, nursing, therapy and diagnostic facilities. In the meantime, acute hospitals should adapt to deliver comprehensive geriatric assessment, and provide for their mental health needs.
Keywords: Aged, Acute hospital, Diagnosis, Disability, Healthcare need, Mental health, Dementia, Delirium Background Single saarlouis hospitals may fail to meet all the needs of older people with co-morbid mental and behavioural disorders, including cognitive impairment, mood, alcohol problems and psychosis [ 1 ].
Two-thirds of older people in hospital have a mental disorder [ 2 ]. Twenty-five per cent of acute hospital beds accommodate someone with dementia, a proportion likely to rise given the ageing population and increasing prevalence of dementia [ 13 ].
A third of all patients admitted to general hospitals for acute care have delirium or dementia [ 4 - 7 ]. People with dementia are 1. Delirium is common in hospitalised older patients, especially those with dementia [ 10 ].
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Both delirium and dementia are associated with excess mortality and the need for institutionalisation [ 46 - 81112 sarah goldberg single. Much emphasis has been placed on mental health assessment and the provision of appropriate psychological and emotional sarah goldberg single [ 213 ].
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However, there has been little investigation of medical needs in sarah goldberg single population. Several large studies have looked at reasons for admission sarah goldberg single people with dementia, basing their data on discharge or insurance records [ 89 ]. Pneumonia, urinary tract infections UTIfalls and fractures are all common diagnoses [ 814 - 16 ].
It has been suggested that some patients are admitted unnecessarily, with conditions which could have been prevented or treated in primary care. Diagnoses reported to lead to admission are dependent on service configuration and data collection methods, and vary greatly between published studies.
There is also a problem in assigning a single reason for admission in frail older adults, for whom comorbidity is common, and presentations often non-specific [ 18 ]. There is a debate about where frail older people who have combinations of problems affecting their physical and mental health should be treated [ 19 sarah goldberg single.
Note: In lieu of an abstract, this is the article's first page.
With increasing emphasis on, and provision of, community services giving alternatives to hospital sarah goldberg single, the number and case mix of patients is likely to change over time, making up-to-date information important in providing services. We aimed to document partnersuche angststörung, problems, and healthcare interventions undergone by a sample of patients admitted to an acute general hospital who were identified as having a concurrent mental health diagnosis.
Methods Study population We recruited participants from two sites of an bed teaching hospital providing sole general medical and trauma services for a population of approximately[ 520 ].
Consecutive patients aged over 70 with an unplanned admission lasting two or more days, were screened for inclusion if admitted to one of 12 wards, comprising two trauma orthopaedic, three acute geriatric medical and seven general medical wards.
Those with a possible mental health diagnosis were identified by responses on the Abbreviated Mental Test score [ 21 ], four-point Geriatric Depression Score [ 22 ], CAGE alcoholism questions [ 23 ] and a question asking if there was any other reason to suspect a mental health diagnosis, sarah goldberg single were invited sarah goldberg single take part in the study.
Written consent was taken from patients who had mental capacity; otherwise agreement was gained from a personal sarah goldberg single a family member or other individual, who, under English Mental Capacity law, can give agreement to a person taking part in research if they lack capacity.
Fifty- three patients underwent a clinical assessment by a geriatrician.
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They were selected opportunistically, depending on availability of the research doctors, and all agreed to take part. Assessments Participants, and sarah goldberg single family carer where one was available and willing, were interviewed by a researcher, who also examined the case notes. Patients sub-sampled for diagnostic assessment were separately and independently assessed by one of three geriatricians, one consultant and two senior trainees. They were asked to complete a clinical assessment at the level expected for a thorough ward consultation, by examining case notes and investigations, talking to the patient and carers, and undertaking any further clinical examination required.
No additional investigations were ordered. Proformas were completed detailing diagnoses, problems, social situation and contextual factors, interventions, including drugs stopped and started, and outstanding healthcare needs.
Diagnoses were further classified as active, potentially active or inactive at any time during the index admissionand level of diagnostic certainty as definite, probably or possible.
Problems were defined clinically as issues considered important for the management of the case, and broadly represented risk factors, impairments or functional problems activity limitationsand were qualified as explained or unexplained. Healthcare interventions undertaken by doctors, nurses and allied health professionals were noted if they were recorded in the case notes. After hospital discharge professional coders routinely assigned a main admission diagnosis, working to a national coding manual, independently of clinicians and research sarah goldberg single.
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