Caring for the whole person: Physical healthcare of older adults with mental illness: Integration of care
This Report, produced by the Royal College of Psychiatrists' Faculty of Old Age Psychiatry and endorsed by the BGS, highlights the multiple physical health needs of older adults with mental illness, particularly those in psychiatric in-patient wards. The report covers the most commonly encountered co-morbid conditions and it provides both practical advice for front line staff as well as making recommendations on training and commissioning of services to help achieve better outcomes for older people. It emphasises the value of an integrated collaborative approach to care.
The Report reflects the fact that older people with mental illnesses in psychiatric inpatient wards are often unable to access advice from geriatricians whilst on the ward and have to either attend A and E as an emergency or go to hospital and wait in an out-patient clinic to be seen. This is in complete contrast to the acute medical wards where older people with physical health issues can get expert mental health advice from liaison services whilst on the ward. The report recommends that this is addressed by commissioning liaison geriatricians to support older adult mental health services in in-patient settings and in the community.
We welcome this report which highlights the importance of meeting the physical healthcare needs of patients over 65 with a mental disorder. Older people have a high prevalence of complex and long-term conditions and there is a direct correlation between physical and mental health. Access to specialist medical advice to help these older patients manage other co-morbidities is therefore vital in improving outcomes on both fronts. We hope that healthcare professionals review this report’s practical advice, and NHS commissioners and managers adopt the recommendations for teaching, training, and commissioning of services that recognise the unique needs of older patients with a psychiatric illness.”
- Professor Tahir Masud, President of the British Geriatrics Society
Whilst there has been an increasing focus on better integration of services to improve the physical and mental health of patients, much of this has centred around people who are under the age of 65. The number of people aged 65 and over in England is expected to have increased by around 30% by 2030, so it is essential we draw attention to this group.
The needs of those over the age of 65 are often different from others’, with increasing frailty, multi-morbidity and an increased prevalence of cognitive impairment and dementia. The presentation of psychiatric illness in older people can be very different to working age adults, and the management of these conditions needs to take into account other co-morbidities. In addition, those with physical health problems are more at risk of developing a mental disorder. It is therefore important that services become more integrated and that the specific needs of the older population are recognised. Geriatricians and old age psychiatrists are both experts in the needs of this patient group.
This report highlights the physical health issues that older adults with mental illness can have, and recommends access to specialist medical advice for those in older people’s in-patient wards, similar to the acute hospitals where older people with medical issues can access older adults’ liaison psychiatry services.
This update to Occasional Paper 100 (OP100) provides an opportunity for improving care for older people. We hope that it encourages service managers, commissioners, and policy makers to consider the needs of this group.
- Professor Wendy Burn, President, RCPsych; Dr Amanda Thompsell, Chair, Faculty of Old Age Psychiatry and Professor Tahir Masud, President, British Geriatrics Society
- List of contributors
- Executive summary
- Summary of OP100 recommendations
- Physical healthcare of older adults with mental illness