Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T04:04:52.208Z Has data issue: false hasContentIssue false
  • English
  • Français

Mental capacity assessments among general hospital inpatients referred to a specialist liaison psychiatry service for older people

Published online by Cambridge University Press:  01 August 2009

Fedza Mujic ,
Maite Von Heising ,
Robert J. Stewart  and
Martin J. Prince
Fedza Mujic*
Affiliation:
South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, London, U.K.
Maite Von Heising
Affiliation:
South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, London, U.K.
Robert J. Stewart
Affiliation:
Institute of Psychiatry, Section of Epidemiology, King's College London, U.K.
Martin J. Prince
Affiliation:
South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, London, U.K. Institute of Psychiatry, Centre for Public Mental Health, Health Service and Population Research Department, King's College London, U.K.
*
Correspondence should be addressed to: Dr F. Mujic, South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, U.K. Phone: +44 20 32995854; Fax: +44 20 32995855. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Mental capacity has been little studied among older general hospital inpatients.

Methods: A retrospective analysis was undertaken of routinely collected data (age, gender, ethnicity, admission diagnosis, psychiatric diagnosis, Mini-mental State Examination score, whether capacity was assessed, the outcome of that assessment, and discharge destination) on referrals to a liaison psychiatry service for older people (2003–2006) from medical and surgical teams at a large London teaching hospital.

Results: 1267 patients were referred to the service, of whom 379 (30%) were assessed for capacity. The most common mental capacity issues were placement (303 assessed of whom 54% lacked capacity), treatment (86 assessed, 59% lacking capacity) and finances (70 assessed, 79% lacking capacity). Cognitive impairment, dementia and delirium, rather than mental disorders were associated with incapacity. Those assessed and deemed to lack capacity for placement decisions were twice as likely to be placed in a care home, and four times as likely to be placed in an elderly mentally ill (EMI) facility, independent of dementia diagnosis and cognitive functioning.

Conclusion: Referrals to a liaison psychiatry service for older people for assessment of mental capacity are common. The main mental capacity issues in older people were those linked to discharge planning. The relatively high proportion of those found to have capacity when capacity had been queried by referring clinicians attests to the important role of specialist liaison teams, particularly in complex cases, in protecting the autonomy of vulnerable older people, and avoiding institutionalization.

Keywords

mental capacity issuesolder peopleliaison psychiatrygeneral hospital
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 4 , August 2009 , pp. 729 - 737
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Applebaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357, 1834–1840.CrossRefGoogle Scholar
Ball, C. and MacDonald, A. (2002). Clinical capacity assessment. Psychiatric Bulletin, 26, 394.CrossRefGoogle Scholar
Benbow, S. and Dawson, G. H. (1996). Liaison in old age psychiatry, In Guthrie, E. and Creed, F. (eds.), Liaison Psychiatry. College Seminar Series (pp. 220–237). London: Gaskell.Google Scholar
Brindle, N. and Holmes, J. (2005). Capacity and coercion: dilemmas in discharge of older people with dementia from general hospital settings. Age and Ageing, 34, 16–20.CrossRefGoogle ScholarPubMed
Cairns, R., Evans, J. and Prince, M. (2004). The impact of NICE guidelines on the diagnosis and treatment of Alzheimer's disease among general medical hospital inpatients. International Journal of Geriatric Psychiatry, 19, 800–802.CrossRefGoogle ScholarPubMed
Cairns, R. et al. (2005a). Prevalence and predictors of mental incapacity in psychiatric in-patients. British Journal of Psychiatry, 187, 379–385.CrossRefGoogle ScholarPubMed
Cairns, R. et al. (2005b). Reliability of mental capacity assessment in psychiatric in-patients. British Journal of Psychiatry, 187, 372–378.CrossRefGoogle ScholarPubMed
Christensen, K., Haroun, A., Schneiderman, L. J. and Jeste, D. V. (1995). Decision making capacity for informed consent in the older population, Bulletin of the American Academy of Psychiatry and the Law, 23, 353–365.Google ScholarPubMed
Department for Constitutional Affairs (2005). Mental Capacity Act 2005. http://www.opsi.gov.uk/acts/acts2005/20050009.htm (last accessed 1 July 2008).Google Scholar
Dunn, L. B., Nowrangi, M. A., Palmer, B. W., Jeste, D. V. and Saks, E. R. (2006). Assessing decisional capacity for clinical research or treatment: a review of instruments. American Journal of Psychiatry, 163, 1323–1334.CrossRefGoogle ScholarPubMed
Etchells, E. et al. (1999). Assessment of patient capacity to consent to treatment. Journal of General Internal Medicine, 14, 27–34.CrossRefGoogle ScholarPubMed
Folstein, M., Folstein, S. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Grisso, T., Appelbaum, P. S., Mulvey, E. P. and Fletcher, K. (1995). The MacArthur treatment competence study. II Measures of abilities related to competence to consent to treatment. Law and Human Behavior, 19, 127–148.CrossRefGoogle ScholarPubMed
Grisso, T., Applebaum, P. S. and Hill-Fatouhi, C. (1997). The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions. Psychiatric Services, 48, 1415–1419.Google ScholarPubMed
Holmes, J., Bentley, K. and Cameron, I. (2003). A U.K. survey of psychiatric services for older people in general hospitals. International Journal of Geriatric Psychiatry, 18, 716–721.CrossRefGoogle Scholar
Jourdan, J. B. and Glickman, L. (1991). Reasons for requests of competency in a municipal general hospital. Psychosomatics, 32, 413–416.CrossRefGoogle Scholar
Kim, S. Y. H., Caine, E. D., Swan, J. G. and Appelbaum, P. S. (2006). Do clinicians follow a risk-sensitive model of capacity determination? An experimental video survey. Psychosomatics, 47, 325–329.CrossRefGoogle ScholarPubMed
Knowles, F. E., Liberto, J., Baker, F. M., Ruskin, P. E. and Raskin, A. (1994). Competency evaluation in a VA hospital – a 10-year perspective. General Hospital Psychiatry, 16, 119–124.CrossRefGoogle Scholar
Martin, R. et al. (2008). Declining financial capacity in patients with mild Alzheimer's disease: a one-year longitudinal study. American Journal Geriatric Psychiatry, 16, 209–219.CrossRefGoogle ScholarPubMed
Ministry of Justice (2008). Mental Capacity Act 2005: Deprivation of Liberty Safeguards – Code of Practice to Supplement the Main Mental Capacity Act 2005 Code of Practice. London: The Stationery Office.Google Scholar
Moye, J. and Marson, D. C. (2007). Assessment of decision-making capacity in older adults: an emerging area of practice and research. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 62, 3–11.CrossRefGoogle ScholarPubMed
Moye, J., Gurrera, R. J., Karel, M. J., Edelstein, B. and O'Connel, C. (2006). Empirical advances in the assessment of the capacity to consent to medical treatment: clinical implications and research needs. Clinical Psychology Review, 26, 1054–1077.CrossRefGoogle ScholarPubMed
Mujic, F., Hanlon, C., Sullivan, D., Waters, G. and Prince, M. (2004). Comparison of liaison psychiatry service models for older patients. Psychiatric Bulletin, 28, 171–173.CrossRefGoogle Scholar
Owen, G., Richardson, G., David, A. S., Szmukler, G., Hayward, P. and Hotopf, M. (2008). Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study. British Medical Journal, 337, 40–42.CrossRefGoogle ScholarPubMed
Palmer, B. W., Dunn, L. B., Appelbaum, P. S. and Jeste, D. V. (2004). Correlates of treatment-related decision-making capacity amongst middle-aged and older patients with schizophrenia. Archives of General Psychiatry, 61, 230–236.CrossRefGoogle Scholar
Palmer, B. W., Dunn, L. B., Depp, C. A., Eyler, L. T. and Jeste, D. V. (2007). Decisional capacity to consent to research among patients with bipolar disorder: comparison with schizophrenia patients and healthy subjects. Journal of Clinical Psychiatry, 68, 689–696.CrossRefGoogle ScholarPubMed
Rao, R. (2001). Sadly confused: the detection of depression and dementia on medical wards. Psychiatric Bulletin, 25, 177–179.CrossRefGoogle Scholar
Raymont, V. et al. (2004). Prevelence of mental incapacity in medical inpatients and associated risk factors. The Lancet, 364, 1421–1427.CrossRefGoogle Scholar
Raymont, V., Buchanan, A., David, A. S., Hayward, P., Wessely, S. and Hotopf, M. (2007). The inter-rater reliability of mental capacity assessments. International Journal of Law and Psychiatry, 30, 112–117.CrossRefGoogle ScholarPubMed
Ripley, S., Jones, S. and MacDonald, A. (2008). Capacity assessment on medical in-patients referred to social workers for care home placement. Psychiatric Bulletin, 32, 56–59.CrossRefGoogle Scholar
Stewart, R. (2004). Assessment of capacity – is it really our job?, Old Age Psychiatrist, 34, 7.Google Scholar
Whelan, P., Lawson, K. and Burton, S. W. (2007). Service innovation: an old age liaison psychiatry service. Psychiatric Bulletin, 31, 145–147.CrossRefGoogle Scholar
Wong, J. G., Clare, I. C. H., Gunn, M. J. and Holland, A. J. (1999). Capacity to make health care decisions: its importance in clinical practice, Psychological Medicine, 29, 437–446.CrossRefGoogle ScholarPubMed