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

• Published in: Age and ageing 2001-05, Vol.30 (3), p.243-249
• Main Authors: Simmons, Peter, Richardson, Barbora, Mullan, Eleanor, Katona, Cornelius, Walker, Zuzana, Orrell, Martin
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Care and treatment; Continuing care; Criteria; Elderly; Eligibility; eligibility determination; Female; health planning; Health services; Health Services for the Aged - legislation & jurisprudence; Humans; Institutional care; Long term health care; long‐term care; Male; Mental disorders; Mental Disorders - classification; Mental illness; Mentally ill elderly people; National Health Programs - legislation & jurisprudence; National health services; Older people; Psychological aspects; United Kingdom
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/30.3.243

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.