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Age and Ageing 2001; 30: 243-249
© 2001, British Geriatrics Society

Research papers

Eligibility criteria for elderly mentally ill continuing-care National Health Service patients: are they being met and do they need revision?

Peter Simmons, Barbora Richardson1, Eleanor Mullan2, Cornelius Katona3, Zuzana Walker3 and Martin Orrell3,

Enfield Community Care NHS Trust, Chase Farm Hospital, Enfield, Middlesex, UK
1 Princess Alexandra Hospital, Harlow, Essex, UK
2 Kingston District and Community Healthcare NHS Trust, Twickenham, Middlesex, UK
3 Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, University College London, Wolfson Building, 48 Riding House Street, London W1N 8AA, UK

Abstract

Background: in 1996, the British government directed health authorities to draw up local eligibility criteria for National Health Service continuing health care.

Objectives: to examine whether elderly mentally ill continuing-care National Health Service patients fulfilled a variety of eligibility criteria for their placement, and to identify the characteristics of patients who met local eligibility criteria.

Design: descriptive study.

Setting: four continuing-care units for elderly mentally ill patients in and around London.

Subjects: 67 continuing-care inpatients.

Methods: interview with nurse carer and, where possible, the patient with the use of standard global, functional, behavioural and cognitive rating scales. We determined fulfilment of Royal College of Psychiatrists' guideline criteria and three local eligibility criteria for elderly mentally ill continuing care. We identified clinical differences between those eligible and ineligible.

Results: although there were wide variations between local eligibility criteria, their effects were the same. In total, 58% of patients fulfilled all local eligibility criteria; 42% fulfilled none. Patients who fulfilled local eligibility criteria scored much higher on ratings of aggression, activity disturbance (wandering, and purposeless and inappropriate activity) and paranoid and delusional ideation. Ten percent of patients fulfilled Royal College of Psychiatrists' criteria but not local eligibility criteria.

Conclusions: comprehensive and unambiguous national eligibility criteria should be introduced to reflect clinical needs and provide equity of access.

Keywords: aged, eligibility determination, health planning, long-term care, mental disorders


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