The HOME study - Michael Sharpe s CBT for the elderly

Sly Saint

Sly Saint

Senior Member (Voting Rights)
The HOME Study

The HOME Study

NHS general hospitals have more than two million unplanned admissions of people aged 65 and older every year. These patients typically spend more time in hospital than those aged under 65. Long hospital stays are bad for older patients: they can get new illnesses like infections and lose their independence. They are also bad for the NHS which has a shortage of hospital beds.

Psychological problems, like dementia, confusion, depression and anxiety, are common in older patients and these are an important cause of long hospital stays. These problems are often not identified in busy hospital wards where the focus is on patients’ physical illnesses.

In this study, we will research whether adding a new approach (sometimes called Proactive Liaison Psychiatry) to the identification and management of psychological problems reduces the time that older people spend in acute general hospital wards.

We will recruit approximately 3,500 patients aged 65 and older, who have been admitted to acute wards in hospitals in Oxfordshire, Cambridgeshire and Devon. They will be randomly allocated to receive usual care, or usual care plus the new approach (which will involve seeing a doctor or nurse who specialises in psychological problems in the medically ill). We will study whether the new approach reduces the time that patients spend in hospital and whether it improves their quality of life and independence. We will also interview patients, carers and healthcare professionals to learn about their experiences of the new approach.

The study is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme.
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https://oxfordpsychologicalmedicine.org/research/thehomestudy/

Research assistant Job being advertised
"We are looking for two highly motivated and enthusiastic research nurses / research assistants to join the Oxford Psychological Medicine team. You will work with clinicians and researchers on The HOME Study, a major NIHR funded multicentre clinical trial led by Professor Michael Sharpe and Dr Jane Walker."
http://jobs.ouh.nhs.uk/job/UK/Oxfor...edicine/Psychological_Medicine-v929296?basic=
 
I (almost) can't believe he's actually going there - "the elderly cost too much" :jawdrop:

And dementia is a cognitive symptom usually caused by a neurological disease. It's not a psychological problem, and it can't be fixed with a dose of the fuck-off variety of CBT.

It's also worrisome that they're targeting people hospitalized for biomedical reasons :cautious:
 
Hospitalization can also cause confusion, that is interpreted by the hospital staff as dementia. When the family try to tell the staff that the patient does not have dementia, they are seen as being in denial and the patient is given anti-psychotic drugs.
 
Valentijn said:
I (almost) can't believe he's actually going there - "the elderly cost too much" :jawdrop:

And dementia is a cognitive symptom usually caused by a neurological disease. It's not a psychological problem, and it can't be fixed with a dose of the fuck-off variety of CBT.

It's also worrisome that they're targeting people hospitalized for biomedical reasons :cautious:
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It all makes sense in twisted and evil way: they're targeting those who cannot fight back.
 
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That's a huge study - 3500 patients. It must be costing a fortune. Should take Sharpe nicely up to retirement age.

And the main reason for 'bed blocking' long hospital stays in the elderly is lack of properly funded support services so elderly people can get out of hospital and go home or into a nursing home and be cared for properly there.
 
Trish said:
That's a huge study - 3500 patients. It must be costing a fortune. Should take Sharpe nicely up to retirement age.
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£5 million or so will save billions when they deliver this shit instead of real treatments and investments.

It will also make the bottom line look great for the big private sell off of healthcare so many lobbyists are desperate to see.

Always got to cook the books a bit before a sell out!
 
Little Bluestem said:
Hospitalization can also cause confusion.
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Indeed. When I was in hospital last year I was given a sleep drug that I reacted badly to, causing intense hallucinations, severe amnesia and confusion. Because I had ME, a lot of the staff didn't believe that I had no memory or awareness of things that were happening (just as they didn't believe in my physical limitations), and thought my confusion was a mental health issue related to the ME.

Eventually I figured out myself what the cause of the problem was, and told the hospital, but presumably my drug chart wasn't updated, because the temp agency staff still tried to give me the drug every night. In fact there were multiple, repeated errors in the meds I was given.

I queried my meds so many times that in the end the night staff were told to just give me what I said I was supposed to have. It really made me wonder what was happening with the drugs being given to my elderly room mates, both over 90 years old, who just took whatever they were given.

I can just imagine people being offered CBT to 'treat' iatrogenic confusion, especially older PwME.
 
Psychological problems, like dementia
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Dementia is a physical problem, not a psychological problem :

dementia_s6_healthy_brain_severe_ad.jpg


How is any form of psychological treatment going to slow down or reverse the destruction of brain tissue?

And how can people with brains like swiss cheese live independently and manage to cook and feed themselves, clean themselves and their clothes, keep their houses/flats clean, and manage their finances?

If they are considered to be an "expensive nuisance" in hospitals as is implied in the description of this study and they don't have anyone to care for them, what do psychiatrists want done with them?

I find it astonishing that anyone could have approved this study - it just looks like a huge waste of money, and is guaranteed to make people's last years on the planet more miserable than they might otherwise have been.
 
Indigophoton said:
temp agency staff still tried to give me the drug every night.
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It's scary things haven't improved much since the 60s then.

My dad was involved in an industrial accident and hospitalized. A nurse tried to bully him into an injection and was quite abusive when he wouldn't let her inject him until she told him what was in the syringe.

Just as well. She finally told him it was a syringeful of penicillin, despite a big red sticker on his chart announcing he was allergic to it. She could have killed him.

But no - it was him being difficult. It is frighteningly easy to imagine an elderly person being dismissed as being a bit senile in a similar situation.
 
For those with no family to advocate for them this will be another kafkaesque nightmare. The vulnerable as a profit vehicle.
If CBT does not cut it then what?
Just look at tonight's dispatches programme - undercover in a Priory mental health unit and weep.
 
For more details of what Liaison Psychiatry is
https://mentalhealthpartnerships.co...ence-base-for-liaison-psychiatry-services.pdf

Excerpts:
  • A very important feature of a liaison psychiatry team is that they spend time listening. It is important to include staff on the team who have the time to listen. This does not have to be expensive, senior staff.
  • There is limited evidence on evaluation of outcomes, but there is descriptive evidence. Descriptive evidence shows a list of benefits including decreased length of stay, reduction in psychological distress, improved service user experience, improved dementia care and enhanced knowledge and skill of general hospital clinicians. Liaison psychiatry services can help reduce bed days/length of stay and prevent unnecessary admissions.
  • Evidence shows the value of working with severe mental illness, older people, people with long-term conditions, medically unexplained symptoms, self-harm and perinatal services.
  • There is a possibility of high impact intervention with re-attenders. There is an example from Hull of liaison psychiatry staff working with Emergency Department staff to assess and follow-up re- attenders which reduced re-attendance by 60%.
  • Evidence shows high value returned from liaison psychiatry services for older inpatients as older people account for 80% of all hospital bed-days occupied by people with co- morbid physical and mental health problems.
I can see that there is a role for psychologists working with some patients, helping to ensure support services are accessed. But when planned outcomes include:
  • Diversions from Emergency Departments
  • Prevalence of frequent re-attending
    • Reductions in admissions to acute and mental health trust beds
    • Reductions in care home admissions
    • Shortening length of stay in acute wards and emergency departments
and knowing that Sharpes' involved, I just know it isn't going to end well.
 
Hutan said:
There is a possibility of high impact intervention with re-attenders. There is an example from Hull of liaison psychiatry staff working with Emergency Department staff to assess and follow-up re- attenders which reduced re-attendance by 60%.
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So stay-home-and-die therapy "works"? :-P But on the plus side, most of the dinosaurs pushing these interventions are old enough to soon be a victim of any success that they have in selling these treatments.
 
ScottTriGuy said:
Medical error is the 3rd leading cause of death in the US.

I don't imagine its much different in Canada, the UK, Europe...
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Based on the description of the study under discussion, "medical error" is going to become a lot more common in order to save money. But the person to be blamed will be the patient themselves because, after all, their problems were all in their heads.
 
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