Holmes John, Bentley Kris, Cameron Ian
University of Leeds School of Medicine, Academic Unit of Psychiatry and Behavioural Sciences, Leeds, UK.
Int J Geriatr Psychiatry. 2003 Aug;18(8):716-21. doi: 10.1002/gps.911.
Psychiatric illness is common in older people in general hospitals, but little is known of the service models operating in the UK, or of the views of old age psychiatrists regarding service provision in this area. We set out to determine the range of UK old age psychiatry service models for older people in general hospital wards, and the opinions of clinicians on future service priorities and development.
A postal questionnaire survey of old age psychiatrists providing psychiatric services to older people in general hospital wards.
73% of services were provided through a generic, sector-based, consultation psychiatry model. The remaining 27% employed a range of general hospital-based liaison psychiatry services for older people, involved in proactively seeking referrals and educating general hospital staff. Those providing a generic sector-based model were significantly slower at responding to referrals. 89% of respondents were unhappy with their service to older people in general hospital wards, with only 11% preferring the generic sector-based model. Organisational barriers to change identified included the management of mental health care and physical care by different organisations. Training, both of psychiatric staff in this specialist area, and of general hospital staff in the detection and basic management of common psychiatric conditions in the general hospital setting, was felt to be necessary.
The management of co-morbid psychiatric and physical illness in older people is an important issue for health services. Old age psychiatrists are unhappy with the prevalent, reactive, consultation-based model, preferring a range of liaison psychiatry models based in the general hospital. The most important barriers to service development in this area were the separate managerial arrangements for psychiatric and physical care services, and a lack of evidence for effective old age psychiatry services in this setting.
精神疾病在综合医院的老年人中很常见，但对于英国现行的服务模式，以及老年精神科医生对该领域服务提供的看法，我们却知之甚少。我们着手确定英国综合医院病房中针对老年人的老年精神科服务模式范围，以及临床医生对未来服务重点和发展的看法。
对为综合医院病房中的老年人提供精神科服务的老年精神科医生进行邮寄问卷调查。
73%的服务是通过基于部门的通用咨询精神科模式提供的。其余27%采用了一系列针对老年人的综合医院联络精神科服务，主动寻求转诊并对综合医院工作人员进行培训。采用基于部门的通用模式的服务机构在回应转诊方面明显较慢。89%的受访者对他们在综合医院病房为老年人提供的服务不满意，只有11%的人更喜欢基于部门的通用模式。确定的变革组织障碍包括不同组织对精神卫生保健和身体护理的管理。人们认为有必要对该专业领域的精神科工作人员以及综合医院工作人员进行培训，使其能够在综合医院环境中识别和进行常见精神疾病的基本管理。
老年人共患精神疾病和身体疾病的管理是卫生服务的一个重要问题。老年精神科医生对普遍存在的、被动的、基于咨询的模式不满意，他们更喜欢一系列基于综合医院的联络精神科模式。该领域服务发展的最重要障碍是精神科和身体护理服务的单独管理安排，以及在这种情况下缺乏有效老年精神科服务的证据。
