Hospitalbased services

Although it appeared earlier this century that inpatient psychiatric services would be overwhelmed by the needs of the ageing population, two major trends have contributed to decreased hospital admission rates of the elderly.(5) These have been the reduction in numbers of traditional psychiatric hospital beds, and the growth in numbers of residential long-term care homes in many countries. Psychogeriatric units are now usually located in district general hospitals, where there is access to geriatric or general medical expertise, laboratory and radiological resources, and day-hospital services. In Canada, some acute units are located within specialized geriatric centres(9l3) and in general hospitals, while others remain in the provincial psychiatric hospitals. (12) Providers based in different types of facility within a catchment area (for example, a general hospital unit, provincial psychiatric hospital, and mental health clinic) may collaborate to stream patients into the appropriate units. For example, the higher functioning or physically frail patient may need admitting to one type of unit (such as the general hospital unit) and the more behaviourally disturbed, but medically stable, patient to another acute unit located in the provincial hospital (which may also provide longer term stabilization if needed), with ultimate discharge to the community or a long-term care setting. In the United States, it is more common for the elderly mentally ill person to be admitted to a general adult psychiatric unit; if longer term stabilization is needed, the patient is then transferred to a state psychiatric hospital.

There remains a need for facilities to accommodate involuntary admission, as well as voluntary, in order to treat the range of psychiatric disorders encountered in this age group. In some areas, separate provision may be made for the treatment of those with dementia from those with 'functional' illness. In either case, adequate staff levels are important. Although there are no firm guidelines, the Royal College of Psychiatrists has made recommendations regarding staff-to-inpatient ratios (five nurses during the day, two of whom must be fully trained, and two to three at night per 20-bed ward) as well as community psychiatric nurses caseloads. (1 2°) The disadvantage of general hospital admission, particularly in a managed-care environment, is that this type of acute care model is often ill-suited to the needs of the frail elderly. Moreover, the pressure to speed things up by, for example, rapidly increasing medication dosages, may predispose to complications such as delirium or falls, resulting in a prolonged stay or unanticipated discharge to a nursing home. Sometimes physical deconditioning can occur in the course of a major depressive illness, and the involvement of a physiotherapist in the multidisciplinary team is essential to restore the person to maximum functional capacity so that discharge to the community is possible. There are advantages to the psychogeriatric unit being physically located within a geriatric treatment and rehabilitation facility; for instance, this permits the sharing of resources as well as geriatric medicine and rehabilitation expertise not usually available in an acute hospital setting.

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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