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Older People Mental Health

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Mental Health: Intervention Skills for the Emergency Services

Abstract

The numbers of older people in society are rising, as are the numbers of people with co-/multimorbidities and polypharmacy, factors that can impact the complexity of care for older people. The Emergency Medical Services (EMS) environment is a complex, noisy and busy setting for older people. The reasons why older people attend EMS are primarily cardiovascular and respiratory conditions; however, issues around assessment for older people who present with delirium and/or dementia add to the importance of a detailed assessment and plan of care. Mental health issues can compound the complexity of assessment and care by the healthcare professionals in the EMS setting, with evidence of longer waiting times and higher rates of admission to hospital for this group of people. Legislation and policy guidance highlight issues relating to capacity, consent, communication and equality. Person-centred care for the older person and the family in the EMS pathway includes involvement in decision-making and in the care process.

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References

  1. World Health Organization. Promoting mental health. Concepts, emerging evidence, practice. Geneva: WHO; 2004.

    Google Scholar 

  2. Sartorius N. Mental health needs, 2015: changes of concepts and consequences. Psychiatry Clin Neurosci. 2015;69:509–11.

    Article  PubMed  Google Scholar 

  3. National Health Service (NHS) Digital. Hospital Accident & Emergency Activity 2019–20. London: NHS Digital; 2020. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident%2D%2Demergency-activity/2019-20/summary-reports

  4. Royal College of Psychiatrists. Who cares wins. London: The Royal College of Psychiatrists. 2005. http://www.rcpsych.ac.uk/PDF/WhoCaresWins.pdf

  5. World Health Organization. Integrated care for older people guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: WHO; 2017.

    Google Scholar 

  6. Bunting BP, Murphy SD, O’Neill SM, Ferry FR. Lifetime prevalence of mental health disorders and delay in treatment following initial onset: evidence from the Northern Ireland study of health and stress. Psychol Med. 2012;42:1727–39. https://doi.org/10.1017/S0033291711002510.

    Article  CAS  PubMed  Google Scholar 

  7. World Health Organization. World health statistics. Geneva: WHO; 2021. https://cdn.who.int/media/docs/default-source/gho-documents/world-health-statistic-reports/2021/whs-2021_20may.pdf?sfvrsn=55c7c6f2_18

  8. World Health Organization. Decade of healthy aging. Geneva: WHO; 2021. https://www.who.int/publications/i/item/9789240023307

  9. Bolton J. Psychiatry in the emergency department. Psychiatry. 2009;8(6):185–8.

    Article  Google Scholar 

  10. Shafiei T, Gaynor N, Farrell G. The characteristics, management and outcomes of people identified with mental health issues in an emergency department, Melbourne, Australia. J Psychiatr Ment Health Nurs. 2011;18:9–16.

    Article  CAS  PubMed  Google Scholar 

  11. Hakenewerth AM, Tintinalli JE, Waller AE, Ising A. Emergency department visits by older adults with mental illness in North Carolina. Western. J Emerg Med. 2015;XVI(7):1142–5.

    Google Scholar 

  12. Goode D, Slater P, Ryan A, Melby V. A comparison of the time spent in emergency departments by older adults with and without mental health needs. Adv Emerg Nurs J. 2021;43(2):145–61. https://doi.org/10.1097/TME.0000000000000350.

    Article  PubMed  Google Scholar 

  13. Gray LC, Peel NM, Andrew P, Costa AP, Burkett E, Dey AB, Jonsson PV, Lakhan P, Ljunggren G, Sjostrand F, Swoboda W, Wellens NIH, Hirdes J. Profiles of older patients in the emergency department: findings from the interRAI multinational emergency department study. Ann Emerg Med. 2013;62(5):467–74.

    Article  PubMed  Google Scholar 

  14. Whittamore KH, Goldberg SE, Gladman JRF, Bradshaw LE, Jones RG, Harwood RH. The diagnosis, prevalence, and outcome of delirium in a cohort of older people with mental health problems on general hospital wards. Int J Geriatric Psychiatry. 2014;29(1):32–40. https://doi.org/10.1002/gps.3961.

    Article  Google Scholar 

  15. McConnell D, McCance T, Melby V. Review: exploring person-centredness in emergency departments: a literature review. Int Emerg Nurs. 2016;26:38–46. https://doi.org/10.1016/j.ienj.2015.10.001.

    Article  PubMed  Google Scholar 

  16. Šteinmiller J, Routasalo P, Suominen T. Older people in the emergency department: a literature review. Int J Older People Nursing. 2015;10(4):284–305.

    Article  Google Scholar 

  17. World Health Organization. World report on ageing and health. Geneva: WHO; 2015.

    Google Scholar 

  18. National Institute for Health and Care Excellence. Older people with social care needs and multiple long-term conditions. London: NICE; 2015.

    Google Scholar 

  19. National Institute for Health and Care Excellence. Achieving better access to 24/7 urgent and emergency mental health care – part 2: implementing the evidence-based treatment pathway for urgent and emergency liaison mental health services for adults and older adults – guidance. London: NICE; 2016.

    Google Scholar 

  20. Royal College of Psychiatrists. The need to tackle age discrimination in mental health. A compendium of evidence. London: RCP; 2009. https://www.rcpsych.ac.uk/pdf/Royal%20College%20of%20Psychiatrists%20-%20The%20Need%20to%20Tackle%20Age%20Discrimination%20in%20Mental%20Health%20Services%20-%20Oct09.pdf

  21. NHS England. Safe, compassionate care for frail older people using an integrated care pathway: practical guidance for commissioners, providers and nursing, medical and allied health professional leaders. London: NHS; 2014.

    Google Scholar 

  22. Naylor C, Imison C, Addicott R, Buck D, Goodwin N, Harrison T, Ross S, Sonola L, Tian Y, Curry N. Transforming our health care system. Ten priorities for commissioners. London: The King’s Fund; 2015.

    Google Scholar 

  23. NHS England. Next steps on the NHS five year forward view. London: NHS England; 2017. www.england.nhs.uk/publication/next-steps-on-the-NHS-five-year-forward-view/

  24. Department of Health, Social Services and Public Safety Northern Ireland. Transforming your care. A review of health and social care in Northern Ireland. Belfast: DHSSPSNI; 2011. http://www.dhsspsni.gov.uk/transforming-your-care-review-of-hsc-ni-final-report.pdf

  25. Wilson G, Montgomery L, Houston S, Davidson G, Harper C, Faulkner L. Regress? React? Resolve? An evaluation of mental health service provision in Northern Ireland. Belfast: Action Mental Health & Queen’s University Belfast; 2015.

    Google Scholar 

  26. Mental Health Foundation. All things being equal. Age equality in mental health care for older people in England. London: Mental Health Foundation; 2009.

    Google Scholar 

  27. Equality Act. London: HMSO. 2010. https://www.gov.uk/guidance/equality-act-2010-guidance#equalities-act-2010-legislation

  28. Department of Health. Closing the gap: priorities for essential change in mental health. London: DH; 2014.

    Google Scholar 

  29. Davies SC. Annual report of the chief medical officer. Public mental health priorities: investing in the evidence. London: Department of Health; 2014.

    Google Scholar 

  30. National Health Service. NHS mental health implementation plan 2019/20–2023/24. London: NHS; 2019. https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation-plan-2019-20-2023-24.pdf

  31. Bradshaw LE, Goldberg SE, Lewis SA, Whittamore K, Gladman JRF, Jones RG, Harwood RH. Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs. Age Ageing. 2013;42(5):582–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Department of Health. The Government’s mandate to NHS England for 2016–17. London: DH; 2017.

    Google Scholar 

  33. Goldberg SE, Whittamore KH, Harwood RH, Bradshaw LE, Gladman JRF, Jones RG. The prevalence of mental health problems among older adults admitted as an emergency to a general hospital. Age Ageing. 2012;41(1):80–6.

    Article  PubMed  Google Scholar 

  34. Pendlebury ST, Klaus SP, Mather M, De Brito M, Wharton RM. Routine cognitive screening in older patients admitted to acute medicine: abbreviated mental test score (AMTS) and subjective memory complaint versus montreal cognitive assessment and IQCODE. Age Ageing. 2015;44(6):1000–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357–63. https://doi.org/10.1370/afm.983.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cheung JTK, Yu R, Wu Z, Wong SYS, Woo J. Geriatric syndromes, multimorbidity, and disability overlap and increase healthcare use among older Chinese. BMC Geriatr. 2018;18:147. https://doi.org/10.1186/s12877-018-0840-1.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Benavidez G, Garrido M, Frakt A. Transforming emergency departments to better care for elderly patients. JAMA Forum Archive. 2018;12 https://doi.org/10.1001/jamahealthforum.2018.0036.

  38. Salvi F, Rossi L, Lattanzio F, Cherubini A. Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit? Intern Emerg Med. 2017;12(2):213–20. https://doi.org/10.1007/s11739-016-1451-5.

    Article  PubMed  Google Scholar 

  39. World Health Organization. The ICD-10 classification of mental and behavioural disorder. Diagnostic criteria for research; 2016. https://icd.who.int/browse10/2016/en#!/F00-F09

  40. The Royal College of Emergency Medicine. Delirium in the elderly. London: RCEM; 2020. https://www.rcemlearning.co.uk/reference/delirium-in-the-elderly/#1568885316660-7e4ed5cb-6911

  41. National Institute for Health and Care Excellence. Delirium: prevention, diagnosis, and management. London: NICE; 2020.

    Google Scholar 

  42. Scottish Intercollegiate Guidelines Network (SIGN). Risk reduction and management of delirium. A national clinical guideline. Edinburgh: NHS Scotland; 2019. https://www.sign.ac.uk/media/1423/sign157.pdf

  43. Royal College of Nursing (RCN). Commitment to care of people living with dementia. SPACE principles. London: RCN; 2019.

    Google Scholar 

  44. Grimmer K, Beaton K, Kumar S, Hendry K, Moss J, Hillier S, Forward J, Gordge L. Estimating the risk of functional decline in the elderly after discharge from an Australian public tertiary hospital emergency department. Aust Health Rev. 2013;37(3):341–7.

    Article  PubMed  Google Scholar 

  45. British Geriatric Society. Silver Book II. Quality urgent care for Older people. BGS; 2021. https://www.bgs.org.uk/resources/resource-series/silver-book-ii

  46. The Royal College of Emergency Medicine. The mental health act in emergency medicine practice. London: RCEM; 2017.

    Google Scholar 

  47. Department of Health. Mental capacity act. London: HMSO; 2005.

    Google Scholar 

  48. The Royal College of Emergency Medicine. Mental health in emergency departments toolkit. London: RCEM; 2021.

    Google Scholar 

  49. National Institute for Health and Care Excellence. Managing self-harm in emergency departments. London: NICE; 2021.

    Google Scholar 

  50. Ameh V, Nasir H, Ahmed S, Abassi A. Improving patient flow in an emergency department. Br J Health Manage. 2018;24(10):486–90.

    Google Scholar 

  51. The American College of Emergency Physicians, The American Geriatrics Society, Emergency Nurses Association, and the Society for Academic Emergency Medicine. Geriatric Emergency Department Guidelines. New York: ECEP/AGS/ENA/SAEM; 2013.

    Google Scholar 

  52. Bridges J. Listening makes sense: understanding the experiences of older people and relatives using urgent care services in England. London: City University; 2008.

    Google Scholar 

  53. Watson WT, Marshall ES, Fosbinder D. Elderly patients’ perceptions of care in the emergency department. J Emerg Nurs. 1999;25(2):88–92.

    Article  CAS  PubMed  Google Scholar 

  54. Cetin-Sahin D, Ducharme F, McCusker J, Veillette N, Cossette S, Vu TTM, Vadeboncoeur A, Lachance PA, Mah R, Berthelot S. Experiences of an emergency department visit among older adults and their families: qualitative findings from a mixed-methods study. J Patient Experienc. 2020;7:346–56. https://doi.org/10.1177/2374373519837238.

    Article  Google Scholar 

  55. The Royal College of Emergency Medicine. Emergency departments care. London: RCEM; 2017.

    Google Scholar 

  56. Royal College of Nursing. National curriculum and competency framework emergency nursing (level 1). London: RCN; 2017.

    Google Scholar 

  57. College of Paramedics. Paramedic curriculum guidance. 4th ed. Bridgewater: TCOP; 2017.

    Google Scholar 

  58. Bunn F, Dickinson A, Simpson C, Narayanan V, Humphrey D, Griffiths C, Martin W, Victor C. Preventing falls among older people with mental health problems: a systematic review. BMC Nurs. 2014;13(4):1–15. http://www.biomedcentral.com/1472-6955/13/4

  59. Faulkner D, Law J. The ‘unnecessary’ use of emergency departments by older people: findings from hospital data, hospital staff and older people. Aust Health Rev. 2015;39(5):544–51.

    Article  PubMed  Google Scholar 

  60. Mather B, Roche M, Duffield C. Disparities in treatment of people with mental disorder in non-psychiatric hospitals: a review of the literature. Arch Psychiatr Nurs. 2014;28:80–6. https://doi.org/10.1016/j.apnu.2013.10.009.

    Article  PubMed  Google Scholar 

  61. Sampson EL, Leurent B, Blanchard MR, Jones L, King M. Survival of people with dementia after unplanned acute hospital admission: a prospective cohort study. Int J Geriatr Psychiatry. 2013;28(10):1015–22.

    Article  PubMed  Google Scholar 

  62. Schnitker L, Martin-Khan M, Beattie E, Jones RN, Gray L. Negative health outcomes and adverse events in older people attending emergency departments: a systematic review. Australas Emerg Nurs J. 2011;14:141–62.

    Article  Google Scholar 

  63. Adams LY, Koop P, Quan H, Norris C. A population-based comparison of the use of acute healthcare services by older adults with and without mental illness diagnoses. J Psychiatr Ment Health Nurs. 2015;22:39–46.

    Article  CAS  PubMed  Google Scholar 

  64. Clissett P, Porock D, Harwood RH, Gladman JR. Experiences of family carers of older people with mental health problems in the acute general hospital: a qualitative study. J Adv Nurs. 2013;69(12):2707–16.

    Article  PubMed  Google Scholar 

  65. AgeUK. Implementing John’s campaign. London: Age UK; 2016. https://www.ageuk.org.uk/contentassets/8e71b5353aa641739a7aa751e7ab0ec5/age-uk-john_s-campaign-guide.pdf

  66. Salehi T, Nayeri ND, Mohammadi E, Mardani-Hamooleh M. Exploring patients’ and family members’ experiences of care in the emergency department. Emerg Nurse. 2020. https://doi.org/10.7748/en.2020.e2008. https://journals.rcni.com/emergency-nurse/evidence-and-practice/exploring-patients-and-family-members-experiences-of-care-in-the-emergency-department-en.2020.e2008/abs

  67. Botes M, Langley G. The needs of families accompanying injured patients into the emergency department in a tertiary hospital in Gauteng. Curationis. 2016;39(1):a1567 ISSN: (Online) 2223-6279, (Print) 0379-857.

    Google Scholar 

  68. McCormack B, McCance T. Development of a framework for person-centred nursing. J Adv Nurs. 2006;56(5):472–9.

    Article  PubMed  Google Scholar 

  69. McCormack B, McCance T. Person–centred nursing theory and practice. Chichester: Wiley-Blackwell; 2010.

    Book  Google Scholar 

  70. Francis R. Report of the mid Staffordshire NHS foundation trust public inquiry. London: The Stationery Office; 2013.

    Google Scholar 

  71. Marynowski-Traczyk D, Broadbent M. What are the experiences of emergency department nurses in caring for clients with a mental illness in the emergency department. Australas Emerg Nurs J. 2011;14(3):172–9. https://doi.org/10.1016/j.aenj.2011.05.003.

    Article  Google Scholar 

  72. Wright ER, Linde B, Rau L, Gayman M, Viggiano T. The effect of organizational climate on the clinical care of patients with mental health problems. J Emerg Med. 2003;29(4):314–21.

    Google Scholar 

  73. Skar P, Bruce A, Sheets D. The organizational culture of emergency departments and the effect on care of older adults: a modified scoping study. Int Emerg Nurs. 2015;23(2):174–8.

    Article  PubMed  Google Scholar 

  74. Stickland N, Gentry T. Hidden in plain sight. The unmet mental health needs of older people. London: Age UK. 2016.

    Google Scholar 

  75. Social Care Institute for Excellence. NICE social care mental health guidance. https://www.skillsforcare.org.uk/Learning-development/social-work/Mental-health-social-work/NICE-social-care-mental-health-guidance.aspx

  76. Osborn R, Moulds D, Schneider AC, Doty MM, Squires D, Sarnack DO. Primary care physicians in ten countries report challenges caring for patients with complex health needs. Health Aff. 2015;34(12) https://doi.org/10.1377/hlthaff.2015.1018.

  77. Goode D, Black P, Lynch J. Person-centred end-of-life curriculum design in adult pre-registration undergraduate nurse education: a three-year longitudinal evaluation study. Nurse Educ Today. 2019;82:8–14. https://doi.org/10.1016/j.nedt.2019.07.009.

    Article  PubMed  Google Scholar 

  78. The Royal College of Emergency Medicine. End of life care for adults in the emergency department. London: RCEM; 2015.

    Google Scholar 

  79. Department of Health (and Concordat signatories). Mental health crisis care concordat – improving outcomes for people experiencing mental health crisis. London: DH. 2014.

    Google Scholar 

  80. Turner J, Bjarkoy M, Coleman P, Goodacre S, Knowles E, Mason S, Nichol J, O’Cathain A, O’Keeffe C, Wilson R. Building the evidence base in pre hospital urgent and emergency care. A review of research evidence and priorities for future research. University of Sheffield: Department of Health. 2010. https://www.sheffield.ac.uk/polopoly_fs/1.43655!/file/Evidence-base.pdf

  81. National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Treat as one bridging the gap between mental and physical healthcare in general hospitals. London: NCEPOD. 2017. https://www.ncepod.org.uk/2017mhgh.html

  82. Harnett PJ, Kennelly S, Williams PA. 10 step framework to implement integrated care for older persons. Ageing Int. 2020;45:288–304. https://doi.org/10.1007/s12126-019-09349-7.

    Article  Google Scholar 

  83. Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res. 2018;18:350. https://doi.org/10.1186/s12913-018-3161-3.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. University of Ulster, Belfast, Northern Ireland

    Deborah Goode

  2. University of Ulster, Derry/Londonderry, Northern Ireland

    Vidar Melby & Assumpta Ryan

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  1. Deborah Goode
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Correspondence to Deborah Goode .

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    Tricia Scott

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Goode, D., Melby, V., Ryan, A. (2023). Older People Mental Health. In: Scott, T. (eds) Mental Health: Intervention Skills for the Emergency Services. Springer, Cham. https://doi.org/10.1007/978-3-031-20347-3_9

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  • DOI: https://doi.org/10.1007/978-3-031-20347-3_9

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