Identified needs of the very old accessing mental health services in Australia and New Zealand.

ObjectivesTo examine identified needs of 'very old' people accessing Australian and New Zealand specialist mental health services and consider service delivery implications.MethodExamination of Australian and New Zealand routine outcome measure data from admissions to specialist mental health services. Comparison of data for over 16,500 admissions of people aged 85 years or over with people aged 65-84 years.ResultsThose aged over 85 have higher total HoNOS65+ scores, driven by raised impairment and social problem subscales, without reduction in symptom subscales. Increased problems were identified in aggression/agitation, cognitive impairment, physical health and activities of daily living items but reduced prevalence of substance related problems. Whilst magnitudes vary, trends are consistent across countries, and across ambulatory and inpatient settings. On admission to Australian inpatient settings, very old age is associated with >30% of people requiring nursing assistance (measured by RUG-ADL), although <10% required two-person assistance on any domain.ConclusionsVery old age at admission to mental healthcare is associated with increasing complexity and nursing support needs, without reduced psychiatric symptoms. This requires consideration in models of care and staff capabilities. The very old with greatest aged-related support needs may be excluded from specialist inpatient care.