At home

The preferred place to assess older patients is in their own homes, although circumstances sometimes dictate that it will be elsewhere. At home patients feel less intimidated and can be seen within an environment which tells the psychiatrist a great deal that he cannot know in the clinic. If a house is filthy and cold and the patient in a similar state, and if there is reliable information that this is only a recent phenomenon, then it is a powerful descriptor of the patient's inability to cope. However, the converse is not always true; a clean and tidy home may only reflect someone else's willingness to support and care for the patient who could not otherwise do it herself (e.g. a daughter or neighbour). Another advantage of a home assessment is that cognitive disabilities, such as dyspraxia and agnosia, can be tested in an ecologically valid way (making tea, recognition of family members from photographs) that is more acceptable to a patient than being formally tested with the Mini-Mental State Examination.(P

Assessments at home require more preparation for the doctor than is necessary at outpatient clinics where equipment for physical examination and blood tests are available, for example. It is an obvious courtesy to the patient to let her know of the visit beforehand, but it is also wise to arrange for a suitable informant to be present. Furthermore, some older patients are incapable of letting visitors into their houses and the informant might well first have to facilitate the doctor's access. Elderly patients are much more likely to be suffering from comorbid physical illness which may be the fundamental cause of the mental disorder, for example pneumonia or a urinary tract infection manifesting delirium. The old age psychiatrist does not therefore need to adhere rigidly to lines of specialty demarcation but rather be aware of the possibility of and prepared to search for physical illness. The basic equipment for a medical examination, such as a stethoscope, sphygmomanometer, and patellar hammer are items to be taken on home visits. Urine testing strips and a thermometer, especially a low-reading thermometer, are also sometimes useful.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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