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Epidemiology studies how regularly diseases occur in different groups of people and why – hence its pivotal role in planning the distribution of resources. This chapter focuses on the epidemiology of mental illnesses in older people in acute hospitals and highlights the role of the liaison psychiatrist and other mental health professionals in bridging the gap between physical and mental disorders. By outlining the intricate connection between the two, it explains why careful consideration and a high index of suspicion are needed when assessing older persons in the acute hospital. Emphasis is placed on the importance of viewing ageing as a normal biological and social construct rather than a problematic disease process to which a figurative cut-off point can be applied. The chapter gives prominence to the mammoth social and economic burden of mental disorders, borne by all in society.
The chapter has subsections on important epidemiological terminologies, life expectancy, the prevalence of common psychiatric disorders in acute general hospitals (including emergency departments), and the influence of COVID-19 on the prevalence of mental disorders in older persons. It sounds a clarion call to challenge current practice, work synergistically with all stakeholders, and embrace change if a crisis is to be averted.
Improving the care provided for people dying in acute healthcare facilities has been identified as a priority for Australian healthcare. Previous observations support the idea that quality care improves outcomes for the dying person as well as for their relatives. To improve care it is essential that there be a clear understanding of which issues require attention. The aim of our project was to improve the understanding of the experiences of family members whose relatives had died on an acute medical ward.
Method:
A mixed-methods approach was adopted for our study. With the approval of the human ethics committee, relatives were approached within three months of the death of their family member and invited to participate in an interview based on a quality-of-dying-and-death (QoDD) tool.
Results:
Of the 50 families approached, 10 agreed to be interviewed. When they were asked to reflect on the experiences of the dying person, the issues that they articulated most strongly related to the need to have time before death to address issues and spend time with important others. With regards to the needs of the dying person's relatives, people articulated strongly that they needed information, support, and evidence of good symptom control. The provision of support post-death was also poignantly highlighted.
Significance of Results:
This study supports observations made in other clinical areas that have identified that timely communication, good symptom control, and ongoing support for both the dying person and their family has important ramifications. Articulating such details is an important part of understanding which aspects of care require attention.
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