Abstract
Background: The population of Dublin’s over 65 year olds in Beaumont catchment area will increase from 24% in 2011 to 44% in 2026 (CSO). Older people occupy 2/3 of acute hospital beds, with 60% of those experiencing mental health difficulties (NCPOP 2018; RCPsych 2005). Beaumont Hospital has a bed capacity of approx. 850 beds, of which 566 will be over 65 and 340 of those will experience mental health difficulties. . Psychiatric co-morbidities complicate the course of general medical conditions and are independently associated with longer hospital stay, decreased function, and mortality (MHC 2020; NCPOP 2018). An Advanced Nurse Practitioner (ANP) post was developed to lead the MHSOP liaison service within the hospital to provide a swift and comprehensive mental health assessment of those referred for assessment, detailing care approaches and management, and where needed follow up into primary care.
Methods: A clinical database was developed by the ANP and was analyzed to identify any trends in referrals using Microsoft excel and anonymizing all data.
Results: There were 434 referrals to the service in 2022. There was a notable increase in those referred for Non Cognitive Symptoms of their Dementia (NCSD) of 10% in 2021 and in 2022. Delirium referrals continued to decrease from 48% in 2021 to 44% in 2022. A significant increase was noted in referrals following suicide attempts and suicidality, from 5% in 2021 to 16% in 2022. There was a highly significant difference between the number of males who were referred post suicide attempt between 2021 (n=1) and 2022 (n=13) with z = +3.21 p< 0.001. Follow up of in-patients by the ANP into primary care increased from 11% in 2021 to 21% in 2022.
Discussion: It was noted that there are 3 main trends of referrals to the service: (1) Dementia, (2) Delirium, and (3) suicidality. The ANP has collaborated with other disciplines both within the hospital and in primary care to help develop the appropriate pathways and support within each of these areas. The ANP is involved in delirium and dementia management and education within the hospital and helped revise the ""Behaviours that Challenge"" policy as well as the ""Delirium Protocol"". The ANP also established a Suicide prevention working group that includes members of Primary Care, National Office for Suicide Prevention (NOSP) and representation from the Clinical Care Programme for Older People (ICPOP). This group is developing a interagency approach to suicide prevention in older people with the launch of a ""Wellbeing Booklet"" for those over 65 years in the catchment area.
Conclusions: The establishment of a detailed clinical database helped to provide valuable information on the changing trends in referrals to the service. The ANP was able to respond to these referrals and by using established models of care and collaborating with other disciplines and services was able to able to make changes to care pathways through integration of care for the older population.