Barber J M, Crean J T
Garnock Day Hospital, Ayrshire Central Hospital, Kilwinning Road, Irvine.
Health Bull (Edinb). 2000 Nov;58(6):471-7.
Guardianship has been used in increasing numbers of elderly mentally disordered Scots in the past decade. During this time, the Community Care Act (CCA) encouraging the provision of care for individuals in their home has been enacted. This study aimed to see if the increased use of guardianship could be due to the use of orders to maintain at-risk elderly people in their homes.
A retrospective survey of all new guardianship orders in people aged 65 or over, comparing those in the two years before the CCA with those in the two years after. Cases were identified using the Mental Welfare Commission (MWC) database. MWC records for the individuals placed on guardianship were examined for data on demographics, social circumstances and perceived risks, together with duration and outcome of orders. Hospital case records were examined for diagnostic information.
All individuals aged 65 or over placed on guardianship under the Mental Health (Scotland) Act 1984 between 1st April 1991 and 31st March 1995.
85 new guardianship orders were identified, 22 before and 63 after CCA. Most were female (82% before and 85% after) and suffered from organic mental disorders (82% before and 84% after). The modal duration of orders for both groups was six months with a trend towards longer orders being noted in the after CCA group. The majority of orders resulted in the placement of the individual in nursing or residential home care (82% before and after CCA).
The increased use of guardianship in elderly mentally disordered individuals is not explained by the use of orders to maintain them at home. It is likelier that the process of social work assessment required by the CCA highlights more cases where guardianship could be used.
在过去十年中，苏格兰越来越多患有精神疾病的老年人受到监护。在此期间，鼓励为居家个人提供护理的《社区护理法案》（CCA）得以颁布。本研究旨在探讨监护使用增加是否可能归因于利用命令让处于风险中的老年人居家。
对所有65岁及以上新监护令进行回顾性调查，比较《社区护理法案》颁布前两年和颁布后两年的情况。通过精神福利委员会（MWC）数据库识别案例。检查被置于监护之下的个人的MWC记录，以获取人口统计学、社会情况和感知风险的数据，以及命令的持续时间和结果。检查医院病例记录以获取诊断信息。
1991年4月1日至1995年3月31日期间根据1984年《精神健康（苏格兰）法案》被置于监护之下的所有65岁及以上个人。
共识别出85项新监护令，《社区护理法案》颁布前22项，颁布后63项。大多数为女性（颁布前82%，颁布后85%），患有器质性精神障碍（颁布前82%，颁布后84%）。两组命令的典型持续时间均为六个月，《社区护理法案》颁布后组有命令持续时间更长的趋势。大多数命令导致个人被安置在护理院或养老院（颁布前和颁布后均为82%）。
老年精神障碍患者监护使用增加并非因利用命令让他们居家所致。更有可能的是，《社区护理法案》要求的社会工作评估过程凸显了更多可使用监护的案例。
