The prognosis of late-life depression in two contiguous old age psychiatry services: An exploratory study

Abstract

A retrospective case-note study of 131 patients with depressive disorder over the age of 65 years discharged over a 3-year period from acute in-patient care in two neighbouring but organizationally distinct old age psychiatry services was made to determine the factors affecting subsequent readmission to hospital and mortality. Dem ographic data, clinical aspects and initial management of patients were similar at discharge with the exception of fam ily history of depression and a measure of social deprivation. Patients from the traditionally organized service (A) had greater lengths of stay in hospital, were m ore likely to be discharged to institutional care and died earlier than patients from the comm unity-focussed service (B). There was a trend for patients from service A to be readmitted sooner than those from service B. Differences in follow-up arrangements re¯ected the differen t models of service organisation employed. Despite the limitations of a retrospective study it is suggested that the results provide the grounds for further prospective examination of the effects of service organization on outcome in depression.

What is the effectiveness of acute hospital treatment of older people with mental disorders?

“…Only three non-randomized comparison studies have examined the overall outcomes (length of stay, readmission rates) of care in PGUs (see Table 1). One of these, a concurrent control study, compared the outcomes of treatment from two neighboring old age mental health services in England with different service styles, and found that over a follow-up period of 5-8 years, 50% of patients were readmitted (Philpot et al, 2000). Readmissions were less likely in the service that had a community orientation, following longer index admissions and where outpatient and community psychiatric nurse follow-ups were arranged (Philpot et al, 2000).…”

“…One of these, a concurrent control study, compared the outcomes of treatment from two neighboring old age mental health services in England with different service styles, and found that over a follow-up period of 5-8 years, 50% of patients were readmitted (Philpot et al, 2000). Readmissions were less likely in the service that had a community orientation, following longer index admissions and where outpatient and community psychiatric nurse follow-ups were arranged (Philpot et al, 2000). Clinical pathways have been used to reduce hospital length of stay (LOS) and hence costs in the management of depression in a PGU (Bultema et al, 1996).…”

A tiered model of psychogeriatric service delivery: an evidence-based approach

“…Medium term effectiveness is enhanced by integration with community care. There is evidence from a concurrent control study that depression relapse prevention is enhanced by integrated post discharge community mental health care in close liaison with the GP when compared with a service with followup through medical outpatients or a day hospital (Philpot et al, 2000).…”

The birth of a specialty: the first ten thousand patients of an old age psychiatry service

“…General psychiatry services for working age adults were expected to continue contact with other aging patients. All consultants had academic contracts and this stimulated several evaluations of the model (Brown et al, 1996;Coles et al, 1991;Collighan et al, 1993;Lindesay et al, 1996;Macdonald et al, 1994;Philpot et al, 2000) as well as the development and elaboration of a system of routine electronic recording of referrals from the start of the first team. This system was originally designed simply to provide team members with a regular list of their patients so that none fell through the net, and it also allowed simple local reports on activity, hitherto a novelty in Mental Health Services in the National Health Service (NHS).…”