At its parallel session in Derry, the Cerebral Ageing and Mental Health SIG focused on liaison psychiatry.

Dr David Anderson, Consultant and Honorary Senior Lecturer in Old Age Psychiatry in Liverpool, reminded us of the always sobering prevalence rates for the big three psychiatric comorbidities: depression, dementia, and delirium. For example, in older patients with hip fracture, delirium has a prevalence rate of a staggering 70%. This has considerable implications: delirium is associated with increased mortality, length of stay and hospital-acquired complications. What is even more concerning is that there is RCT evidence that relatively simple interventions, such as avoiding dehydration, reduce the rates of incident delirium, and yet few hospitals have procedures in place to prevent, detect and treat delirium adequately.

Depression
Detection rates for depression remain low, despite dozens of studies showing prevalence rates of 10-30% in inpatients, and demonstrating at least 60% response to antidepressant treatments. As for dementia, Dr Anderson reinforced the view that hospital admission is particulary hazardous for these patients and that where possible they should be managed in their home surroundings. At the end of a bleak (!) portrait of the fate of patients with psychiatric co-morbidities in medical and surgical wards Dr Anderson summarised the treatments offered as: drugs only, usually the wrong drugs prescribed, or the right drugs administered at the wrong times and in the wrong dosages.

Psychiatric interventions
Dr John Holmes, Senior Lecturer in Liaison Psychiatry of Old Age at the University of Leeds, began his lecture, ‘Psychiatric Service Models for General Hospitals’ with a thought-provoking analysis of the reasons underlying the poor standards of care for older people with psychiatric co-morbities. Focus-group studies with nurses on non-psychiatric wards showed that they feel threatened by patients’ aggressive behaviour, feel inadequately trained, and feel that they are best dealing with other areas rather than their patients’ psychiatric disorders.

Dr Holmes went on to examine infrastructural and cultural barriers to providing adequate psychiatric care on medical and surgical wards, for example the lack of dedicated funding and the lack of understanding among managers of the benefits of psychiatric interventions. He then outlined the service he and his team have developed in Leeds; a striking feature here is his success in persuading his surgical colleagues to part with waiting list monies to fund better assessment and treatment of patients with delirium!

Liaison nursing
Ms Clare Wai, Mental Health Liaison Nurse in Addenbrooke’s, Cambridge, concluded the meeting with a lecture entitled “Liaison Mental Health Nursing - An Evalution”. She took us through the history and development of liaison nursing. The role of such nurses today is not only to provide a consultation service – though this remains a key activity, but also clinical supervision, staff support, education and research. Ms Wai echoed the focus group work described by Dr Holmes, in that her general nursing colleagues feel that they lack the skills and the time to deal with psychiatric problems. General nurses are aware of this deficit though, because the number of referrals to the liaison nursing service is increasing rapidly every year, and in Ms Wai’s Trust the referrals are now over 600 per year.

The three talks potently reinforced the message that the NHS is not doing enough to address the needs of older patients with psychiatric disorders. However, each speaker also showed us that, with determination and creativity, much can be done. After the talks we had a vigorous question and answer session in which we discussed ways and means of improving services.

The session concluded with a brief AGM. Duncan Forsyth remains as Chair, with Roger Bullock replacing John Starr as Secretary, John Holmes replacing David Jolley as Meetings Secretary, and Jim George replacing Noeleen Devaney as Treasurer. Alasdair MacLullich remains Trainee Representative.

Alasdair MacLullich
Lecturer in Geriatric Medicine
University of Edinburgh