Case note audit of lithium use in the elderly

The objective of this audit was to determine the indications for lithium therapy in the elderly and the extent to which derived standards of practice in the administration of lithium therapy were attained. The case notes of 91 patients above the age of 65 years, identified from hospital records as having had blood lithium levels estimated, were perused. Data was obtained from case notes and printouts of laboratory investigations using a questionnaire designed for the study. The indication for lithium therapy was clearly documented in all patients. Lithium administration frequently did not fulfil the standards of practice we had identified from the literature review. Lithium therapy in old age is usually associated with a good outcome. The apparent failure to meet derived standards in the administration of lithium may in part reflect the stringency of the standards we identified as well as the incomplete information derivable from case notes. There is, nonetheless, a clear need to feed the information identified from such research into the audit cycle.