Does a specialist medical and mental health unit (MMHU) improve outcomes compared with standard care for confused older people admitted as an emergency: A service evaluation alongside a controlled clinical trial

Background: Half of people over 70 years of age admitted as an emergency are cognitively impaired. The quality of their hospital care is frequently criticised. Innovation: We established a specialist unit (MMHU) using best practice from literature in an attempt to improve outcomes. Mental health specialists were integrated into the ward team; staff were trained in person centred dementia care; the environment was improved; a programme of purposeful activity introduced; and a proactive and inclusive approach to family carers adopted. Evaluation: The MMHU has been evaluated by a randomised controlled trial, but alongside this we undertook a service evaluation audit for the first 558 patients randomised using routinely held data on hospital admissions and clinical incidents to compare outcomes in the two settings (MMHU and standard care in a general medical or geriatric ward). MMHU patients had spent slightly longer in hospital in the year prior to the index admission. (Table presented) Conclusions: The evaluation did not show any difference in outcomes, apart from an increased rate of falling in the MMHU group. This could possibly represent reporting bias. The outcomes analysed may be dependent on illness severity and external agencies such as social services. We may need to rethink appropriate outcomes for frail older people, emphasising more on quality of experience. We acknowledge that hospital administrative data can be incomplete, and formal trial results are awaited.