Residential care

A range of residential care options, from sheltered housing to skilled nursing facilities, is available in most developed countries for elderly people who are no longer able to live independently in their own homes. Because it is likely that the demand for such accommodation will increase as the numbers of dependent elderly people increase, there is a need for innovative alternatives to the 'warehouse' institutional type model. For instance, the 'domus' model has been developed in the United Kingdom; this is a small residential mental health unit for about 12 elderly people with dementia and other mental illnesses. These units appear to provide a better quality of life for residents than traditional hospital psychogeriatric wards, and staff satisfaction is reported to be better, (2 30> although the service is more costly. (31> There are also district hostels for the mentally impaired elderly in the United Kingdom as well as psychogeriatric nursing homes. In the United States and Canada, dementia special care units have been developed by many long-term care institutions to provide palliative comfort-oriented residential care to individuals with dementia. By 1991, 10 per cent of all nursing homes in the United States had a special care unit. (32) There is considerable diversity amongst these units, and, as yet, there is insufficient evidence as to their efficacy. Existing evidence is somewhat contradictory with regard to cost-effectiveness, although the units appear to provide a greater degree of comfort to residents.(3334)

Despite considerable psychiatric morbidity and behavioural disturbance having been identified among the residents of traditional nursing homes, (3 36) residents of nursing homes usually receive minimal psychiatric care and staff are seldom trained in mental health. In the United States, legislation was introduced in 1987 restricting the use of psychotropic medication, particularly neuroleptics, in nursing homes. (3Z> These regulations, introduced to prevent the use of 'chemical restraint', require that a physician review the indications for the continued use of each psychopharmacological agent at specific intervals, taper the medication, or justify not doing so, and document any side-effects. State surveyors monitor compliance yearly. This has resulted in many nursing homes in the United States retaining pharmacists to conduct these reviews, but there is still little psychiatric involvement. Medicare reimbursement for consultation is minimal, which discourages nursing-home consultation. However, some nursing homes, particularly those associated with teaching hospitals, may contract with a psychogeriatrician for sessional services. Also, the recent development of telemedicine technology offers a potential solution by allowing the psychiatrist to assess the patient from a remote location, and may prove to be of benefit in this area. (38> In parts of Canada, some geriatric psychiatry programmes incorporate interdisciplinary consultation-liaison and educational outreach to nursing homes.(l439) In the United Kingdom, the situation is complicated by the administrative separation of National Health Service specialist services from long-term care, which has made it difficult to ensure that the mental health needs of long-term care residents are adequately addressed. Steps are being taken to address this by the Department of Health, (49 including the education of staff and the increased provision of information to the public. In some countries, notably The Netherlands and Scandinavian countries, progress has been made by the establishment of small publicly funded units comprising 30 to 40 beds that are regularly visited by psychiatrists.

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5 Secrets to Lasting Longer In The Bedroom

How to increase your staying power to extend your pleasure-and hers. There are many techniques, exercises and even devices, aids, and drugs to help you last longer in the bedroom. However, in most cases, the main reason most guys don't last long is due to what's going on in their minds, not their bodies.

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