This research project asks: What are the physical health care and service needs for older people under the care of mental health services?
People with adverse mental health experience reduced life expectancy compared to the general population, known as the “stolen years”. The most significant factor remains physical ill health, which is more prevalent in people with adverse mental health relative to the general population. Much of this risk is modifiable through improved access and uptake of physical health care. However, integration of physical and mental health services has focussed on younger adults, and physical, rather than mental, health trusts. Older adults with mental health problems face distinct challenges, and care models designed for other settings may need to be adapted for this population. Older people with lower socioeconomic status are more likely to experience adverse mental and physical health, and are less likely to access healthcare services. Therefore, this issue will disproportionately affect those from lower socioeconomic backgrounds. Integrated physical-mental health care is one way of tackling this inequality, but it is not widely available, and has not been designed specifically for older people under the care of mental health services.
This study is a partnership with Age UK Leicester Shire and Rutland (L&R) to determine the optimal methods for integrated physical and mental healthcare delivery for older people in mental health settings, and how these can be designed to reduce inequalities particularly in relation to people from lower socioeconomic groups. It will focus on how services can be designed to better support patients and carers in the community following discharge from hospital. This will be achieved through the following mixed methods study:
- Quantitative: data linkage through NHS Digital to determine the number and type of comorbidities experienced by older people under mental health services. Calculation of the comorbidity index and Hospital Frailty Risk Score will define the current level of physical health need for older people under mental health services across England. We will determine the relationship between physical health need (level of comorbidity and frailty) with the following health outcomes: hospitalisation (admitted patient care data), institutionalisation (e.g. new residential or nursing home on discharge), and mortality.
- Qualitative: 60 semi-structured interviews across two mental health trusts (Leicestershire Partnership Trust and Nottinghamshire Healthcare Foundation Trust), with older people, and/or their carers receiving mental health care, mental health practitioners (e.g. doctors, nurses, allied health professionals), managers and commissioners to determine the impact of physical comorbidities on overall health and wellbeing, and to determine how services can be designed to meet these needs.
- Mixed methods: Data from the quantitative and qualitative strands will be integrated to derive recommendations on future service design for older people with physical health care needs under mental health care. A list of recommendations for care delivery will be developed through a focus group with participants drawn from the interview study. The final recommendations will be ratified through the study patient and public involvement steering committee.