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 will research whether adding a new approach (sometimes called Proactive 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.
We will recruit approximately 3,000 patients aged 65 and older, who have been admitted to acute wards in hospitals in Oxfordshire, Cambridgeshire and Devon. They will be randomly allocated to receive usual care, or usual care plus the new approach (which will involve seeing a doctor who specialises in psychological problems in the medically ill). We will study whether the new approach reduces the time that patients spend in hospital and whether it improves their quality of life and independence. We will also interview 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.