A prospective study of domiciliary visits in elderly people with psychiatric problems

Little research has been done on domiciliary visits in old-age psychiatry. In particular, it is not known which clinical and other factors are more likely to result in follow-up by the psychiatric services rather than by the general practitioner without specialist support. The aim of this study was to investigate clinical and other factors associated with psychiatric follow-up after domiciliary visits. It took place in three old-age psychiatry services in the UK covering both urban and rural areas. In all, 197 older people were seen at home by consultants in old-age psychiatry. The data collected included the mini-mental state examination, geriatric depression scale, Clifton assessment procedures for the elderly/behaviour rating scale, and additional data. Most patients had problems that had been present for at least six months. Multivariate analyses indicated that younger patients were more Likely to receive follow-up by the psychiatric services. However, age was confounded by a variety of clinical and diagnostic factors. Reasons for admission were complex but levels of depressive symptoms, suicide risk and not coping all appeared influential. The consultant home visit continues to have a major role in initial assessment and management, and decisions about the most appropriate follow-up.