Psychiatric admission in dementia care—Cultural and social factors may determine outcome

Abstract

Background There is a rising tide of the elderly in developed and developing nations and this would mean that there would be a similar increase in the prevalence of dementia. Data from China and India, which are the most populous nations, suggest this trend and that it will be a major social and health problem. The demented elderly will cause a rapid increase in the contribution to the global burden of disease and disability over the next 20 years unless a miracle cure for dementia is found soon. None of the nations are going to be able to keep pace with the medical needs of the elderly, especially the needs of the elderly suffering from dementia. The finite resources we have need to be managed very carefully. Objective This paper argues that the psychiatric needs of the elderly dementia sufferers can be met without admission to acute inpatient psychiatric units. Apart from a tiny minority, most of the problems can be managed in the community unless they have co-morbid medical problems that need admission to a general medical hospital. The paper argues that most admissions into acute inpatient psychiatric units are mainly for social rather than for psychiatric reasons. Admission might meet the needs of the carer but it is debatable as to whether the needs of dementia sufferers are best met by hospitalisation. On the contrary, we may be doing more harm than good by our interventions. Two examples are given of dementia care in a developed nation and a developing nation. We may be able to learn aspects of dementia care from developing countries.