Carers and the Monitoring of Psychogeriatric Community Teams

Abstract

Objective: To monitor key processes and outcomes in joint health and social services community psychogeriatric teams, from the perspective of principal carers of people with dementia. Design: Interview with carers six months after referral of the 39 community based people with dementia. Overall 34 (87%) principal carers volunteered but 5 refused follow‐up. Setting: Two rural and two urban health and social services teams. All were routine service teams, rather than run for research purposes. District had relatively large long stay inpatient facility but low independent sector provision. Main outcome measures: Measures included avoidable admissions, crises or untoward events, unmet needs, proportion of carers experiencing severe stress assessed on the General Health Questionnaire, the carer satisfaction with service elements. Also comparison of carer and keyworker assessments of carer stress. Results: The majority of patients were female and few were under 75 years old. 93% were severely or totally impaired on the Activities of Daily Living problem score. The principal carers were mostly spouses or children, 56% being female. During the six month period from referral, keyworkers considered that there were 2 avoidable admissions and crisis or untoward events in 18 cases, the largest group being accidents (7). Carers considered needs to be met in 44% of cases. Lack of patient stimulation and carer respite, together with needs for appropriate institutional care, formed the major areas of unmet need. Fifteen of 26 (58%) carers completing the General Health Questionnaire had scores indicating the probable or definite presence of psychological distress. However, keyworker assessments of carer stress showed no correlation with GHQ scores. Fourteen of 32 (43%) considered the services received as of poor or moderate quality. Accounts of problems in arranging and using services highlighted a series of issues requiring management of policy attention. Conclusions: Carer inclusion in the monitoring of joint agency teams is feasible and leads to the identification of a range of practical problems in service configuration and delivery. Keyworker assessments of carer stress may not be valid and direct measurement may be necessary.

What Becomes of People With Dementia Referred to Community Psychogeriatric Teams?

“…One possible aspiration for the service might be to support carers sufficiently to avoid many being under severe stress, at least after 6 months of care. The assessed levels of stress in carers raise concerns, but this is complicated by the finding of high levels of caseness amongst the carers of community resident patients with dementia in the linked study (Melzer et al, 1996) and that keyworker assessments correlate poorly with General Health Questionnaire rating from carers.…”

The role of carers in evaluating mental health services for older people

“…The only such study speci®cally in an old age psychiatry setting was performed in Cambridge, UK Melzer et al, 1996). The study followed up 136 patients referred to four community resource teams over 6 months, looking at patient outcomes (such as survival, institutionalization and unmet needs) and carer outcomes, including carer stress levels measured using the General Health Questionnaire (GHQ, Goldberg, 1978).…”