NHS general hospitals have more than two million unplanned admissions of people aged 65 and older every year. These patients typically spend more time in hospital than those aged under 65. Long hospital stays are bad for older patients: they can get new illnesses like infections and lose their independence. They are also bad for the NHS which has a shortage of hospital beds.
Psychological problems, like dementia, confusion, depression and anxiety, are common in older patients and these are an important cause of long hospital stays. These problems are often not identified in busy hospital wards where the focus is on patients’ physical illnesses.
In this study, we are researching whether adding a new approach (called Proactive Consultation-Liaison Psychiatry or Proactive Psychological Medicine) to the identification and management of psychological problems reduces the time that older people spend in acute general hospital wards.
2,744 patients, who had been admitted to acute wards in hospitals in Oxfordshire, Cambridgeshire and Devon, took part in The HOME Study. They were randomly allocated to receive usual care, or usual care plus the new approach (which involved seeing a doctor who specialises in psychological problems in the medically ill). We are now analysing whether the new approach reduced the time that patients spent in hospital and whether it improved their quality of life and independence. We have also interviewed patients, carers and healthcare professionals to learn about their experiences of the new approach.
The study is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme.