The effectiveness of old age psychiatry services

The objective of this study was to review outcomes of acute service deliver y in old age psychiatry. Sources of data included Medline, PsycINFO and Coc hrane Collaboration databases of English language papers to 1998 on service delivery evaluation in 'old age psychiatry', 'psychogeriatrics' and 'geria tric psychiatry', supplemented by a manual search of references from releva nt literature. All controlled trials, audits, and surveys of the outcomes o f service delivery in old age psychiatry located in acute hospitals and com munity settings were included. Service delivery by medical, adult psychiatr y and consultation/liaison services were included. With the exception of ou treach services to nursing homes, long term institutional care was excluded . All data were extracted by the author. Data quality was assessed by apply ing an evidence hierarchy. Evaluation strategies were qualitatively reviewe d. Controlled trials, audits and surveys were each found to provide importa nt data in the evaluation of service delivery. There is better quality evid ence to support the effectiveness of components of old age psychiatry servi ces than other service types. The majority of studies indicate that old age psychiatry services have positive acute treatment outcomes, particularly w ith depression There is insufficient evidence to determine which processes of care are associated with better outcomes. Pluralistic evaluations indica te that carers often have unmet needs and are not as positive about outcome s. There have been no controlled comparisons of service delivery provided b y other services. In conclusion, controlled trials and audits indicate that old age psychiatry services are effective. Further pluralistic evaluations and comparisons with other services are required. Copyright (C) 2000 John Wiley & Sons, Ltd.