Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs

Abstract

Background: two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission.Methods: a follow-up study of 250 patients aged over 70 admitted to 1 of 12 wards (geriatric, medical or orthopaedic) of an English acute general hospital with a co-morbid mental health problem and followed up at 180 days.Results: twenty-seven per cent did not return to their original place of residence after the hospital admission. After 180 days 31% had died, 42% had been readmitted and 24% of community residents had moved to a care home. Only 31% survived without being readmitted or moving to a care home. However, 16% spent >170 of the 180 days at home. Significant predictors for poor outcomes were co-morbidity, nutrition, cognitive function, reduction in activities of daily living ability prior to admission, behavioural and psychiatric problems and depression. Only 42% of survivors recovered to their pre-acute illness level of function. Clinically significant behavioural and psychiatric symptoms were present at follow-up in 71% of survivors with baseline cognitive impairment, and new symptoms developed frequently in this group.Conclusions: the variable, but often adverse, outcomes in this group implies a wide range of health and social care needs. Community and acute services to meet these needs should be anticipated and provided for.

Advance Directives, Hospitalization, and Survival Among Advanced Cancer Patients with Delirium Presenting to the Emergency Department: A Prospective Study

“…These findings are similar to those in elderly patients with and without delirium in the ED . Interestingly, we found that the median survival of advanced cancer patients with delirium in the ED was only 1.2 months for patients who were CAM‐positive, and these survival outcomes are worse than those of elderly patients with delirium but without cancer in the ED, of whom only 6% died within 1 month in one study and 31%–37% died within 6 months in other studies . Consequently, clinicians caring for advance cancer patients with delirium in EDs should strongly consider focusing on goals of care, resuscitation preferences, and quality of life for patients and their family members.…”

Experience of general hospital care in older patients with cognitive impairment: are we measuring the most vulnerable patients’ experience?

“…These patients are mostly very old (half will be over 85 years old), acutely ill and have many comorbidities 4. Many are reaching the end of their natural life5; there is a palliative element to their care, making the quality of their care and their experience of being in hospital of greater importance. Such patients have many functional problems (incontinence, needing help when moving and assistance with meals) and behavioural and psychological problems (delusions, hallucinations, agitation and aggression and apathy), which together with their acute illness and comorbidities make them especially vulnerable to a poor experience 4.…”

Physical deterioration in an acute mental health unit: A quantitative retrospective analysis of medical emergencies

“…Older patients with comorbid mental illness also have increased morbidity (Bradshaw et al . ). Furthermore, for patients who have a mental illness, rapid tranquilization, the risk of choking, and the consumption of alcohol and illicit drugs exacerbate risk (Unsworth et al .…”

“…In particular, there is good evidence indicating that cardiovascular diseases (hypertension, stroke, myocardial infarction) and nutritional and metabolic diseases (obesity, diabetes, hyperlipidaemia) significantly affect this group (Hert et al 2011) including even young adults (McCloughen et al 2012). Older patients with comorbid mental illness also have increased morbidity (Bradshaw et al 2013). Furthermore, for patients who have a mental illness, rapid tranquilization, the risk of choking, and the consumption of alcohol and illicit drugs exacerbate risk (Unsworth et al 2011) that needs to be managed by staff (Flood et al 2014).…”