International Psychogeriatrics

Research Article

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

Fedza Mujica1 c1, Maite Von Heisinga1, Robert J. Stewarta2 and Martin J. Princea1a3

a1 South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, London, U.K.

a2 Institute of Psychiatry, Section of Epidemiology, King's College London, U.K.

a3 Institute of Psychiatry, Centre for Public Mental Health, Health Service and Population Research Department, King's College London, U.K.

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.

(Received November 05 2008)

(Revised December 04 2008)

(Revised February 04 2009)

(Accepted February 05 2009)

(Online publication May 11 2009)

Correspondence:

c1 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: fmujic@tiscali.co.uk.