Psychogeriatric Day Research Articles

A survey of frontal lobe dementia in a psychogeriatric day unit population

AbstractNine (12%) of 78 consecutive first admissions to psychogeriatric day units fulfilled an operational definition for dementia of frontal lobe type (DFT). These cases showed many of the behavioural, neuropsychological and neurophysiological features of DFT reported in presenile subjects. They accounted for 14% of first admissions with organic brain syndromes and 37% of those showing marked apathy or disinhibition. These findings support the hypothesis that DFT is a common cause of referral to psychogeriatric services and a significant source of behavioural disturbances in such settings.

Psychogeriatric day care outcome: A five‐year follow‐up

AbstractAll 224 consecutive new patients who were admitted in 1982 through 1985 to the day care department of a skilled‐care psychogeriatric nursing home were followed longitudinally until death. Dementia was diagnosed in 95.1% of the 133 women and 91 men. Their mean age at admission was 78.7 years (SD = 7.4). Every 12 months after their initial attendance the patients' status was recorded and coded as living in the community, institutionalized or dead. At one year after initial attendance 99 (44.2%) patients still resided in the community, 94 (42.0%) were admitted to a nursing home or (psychiatric) hospital and 31 (13.8%) had died. At five years only nine (4.0%) patients resided in the community, 65 (29.0%) were in long‐term institutional care and 150 (67.0%) had died. Age, gender, socioeconomic status or living alone did not contribute to first‐year outcome, but severity of cognitive impairment was associated with an increased risk of becoming institutionalized. Using logistic regression analysis, a model of three variables, living at home, needing help from caregiving children, and high ratings of dependency, assigned 61.4% of 176 subjects correctly as institutionalized versus residing in the community.

A social network in a psychogeriatric day hospital

A social network in a psychogeriatric day hospital

A follow‐up study of psychogeriatric day hospital patients with dementia

AbstractOne hundred and fifty‐five patients suffering from dementia who attended a psychogeriatric day hospital in 1985 were reviewed three years later. This review was performed to determine what proportion of discharges from the unit were unplanned or unforeseen and to look for any patterns in the care experienced by different groups of patients. The discharges were classified as planned or unplanned and by the living circumstances to which discharged. The outcome of patients surviving at follow‐up was also classified by living circumstances. Forty‐five per cent of discharges were unplanned. Significant differences were noted when comparing patients who had been living alone and those living with their spouses. The former, if institutionalized, were more likely to be admitted to a residential or nursing home whereas the latter were more likely to have been admitted to hospital. More of those living alone were alive at follow‐up. The findings of this study support the view that day hospital provision has little effect on the eventual need for long‐term care and that this need is related to the attitude and stamina of careers.

Paranoid features in the elderly with dementia

AbstractNinety‐two consecutive psychogeriatric day hospital referrals were assessed using the Camdex schedule. Sixty‐six of the patients had a first‐degree relative visiting more often than once per week and the data from the patient and informant sections of these schedules were analysed to assess the prevalence of paranoid features. Overall, 36.4% fulfilled the modified criteria for paranoid disorder. Significantly more patients with Alzheimer's disease fulfulled these criteria than did those with vascular dementia, and paranoid features were most common in patients with dementia of moderate severity.

Carers Support Groups: Meeting the Needs of Carers and Staff

This article describes a carers support group within a psychogeriatric day hospital and presents the results of a study. The study aimed to evaluate the effectiveness of the groups in meeting the needs of the carers, examine the opinions of the staff and the carers, and determine whether running the groups had any positive effect on staff morale. Results showed that most carers found the groups beneficial but that they did not perceive the staff to be as effective as the staff believed themselves to be; that relief to carers appeared to be more effectively provided by the attendance of their relative at the day hospital rather than at the carers support groups; and that the groups had a positive effect on staff morale by providing an opportunity for the staff to work together, feel more part of a multidisciplinary team and develop relationships within it. Possible changes that could increase the effectiveness of the groups are identified.

Drug Compliance amongst Psychiatric Day Hospital Attenders

Drug compliance was assessed amongst all 91 patients attending a psychogeriatric day hospital during July 1988. Of the 86 patients taking medication, the 57 functionally and 29 organically ill patients were interviewed at home, the latter with their carers. A disparity in results was shown when compliance was measured by two different means: by dose indices and by tablet counts. Functionally ill patients had a better dose compliance but there was no difference between the groups when assessed for tablet-count compliance. The unreliability of using a single tablet count as a measure of compliance is discussed. Little correlation was shown between reduced compliance and increased numbers of medications. Assessment of patients' comprehension of the purpose of their medications revealed that those most poorly understood were lithium and carbamazepine, the best understood were analgesics and hypnotics. Non-prescribed medication constituted only 2% of the total medications being taken.

Impact of Day Care on Dementia Patients–Costs, Well-being and Relatives′ Views

Forty-seven patients in psychogeriatric day centre were analysed regarding use of resources, costs and well-being. The level of well-being was based on interviews with staff and relatives and related to the economic outcome--a cost utility analysis. A 6 month period prior to day care was compared with the first 6 months in such care. The use of resources at home increased by 20% while the use of institutional care was reduced by 22%. Fifty-three percent of the patients improved in their well-being after participation in day care. When the cost of utility analysis was applied, the cost for a well-year was 4293 pounds.

The geriatric mental state schedule administered with the aid of a microcomputer: A pilot study

AbstractA version of the Geriatric Mental State Schedule developed for the microcomputer is described and compared to the usual paper version of the questionnaire. The advantages and disadvantages of the two techniques are discussed. A feasibility study of the microcomputer‐administered questionnaire is described. A shortened version of the Geriatric Mental State Schedule (version A) is administered to a number of geriatric patients attending psychogeriatric day hospitals. The study compares the microcomputer‐administered with the pencil‐and‐paper questionnaire. Two raters administer the questionnaire using the two techniques to a group of patients and the reliability is evaluated by comparing the correlation coefficients for the scores obtained on the questionnaire, as well as by evaluating Cohen's kappa statistic. The correlation results show that there is significant positive correlation between the paper and the microcomputer‐administered questionnaire. However, the kappa values comparing diagnoses obtained with the AGECAT program are not high and reasons for this are discussed. Further developments of the system, including an authoring program (QUESTLAN) for such questionnaires and the use of portable microcomputers in the community, are discussed.

Correlation between the 37-item mental test score and abbreviated 10-item mental test score by psychogeriatric day patients.

Groups of organically and functionally mentally ill psychogeriatric day patients were assessed by the 37-item Roth-Hopkins test and the abbreviated ten-item Roth-Hopkins test. The scores correlated highly, correlation being equally good for both diagnostic groups. Among the functionally ill and the mild organically ill, scores improved between first and second test. The quicker, better tolerated ten-item test is a useful test of mental impairment for psychogeriatric patients in the community, as well as in institutional care.

Influence of emotional distress among supporters on the outcome of psychogeriatric day care.

From a sample of consecutive referrals for psychogeriatric day care, the influence of the supporters' emotional distress and self-reported strain, together with the number of problems presented by the patient, was examined in relation to outcome, 6-7 months after initial attendance. A higher level of problems and the failure to achieve any reduction in reported distress were both found to contribute to the breakdown of community care and to the subsequent institutionalisation of the patient. Day hospital care was associated with a significant reduction in emotional distress for the majority of relatives, although for relatives whose distress was not alleviated by their dependents' attendance, admission to long-term care did produce such a reduction.

Predicting the outcome of psychogeriatric day care

Predicting the outcome of psychogeriatric day care

Psychometric prediction of psychogeriatric day care outcome.

A comparison was made between sets of psychometric variables [the Clifton Assessment Procedures for the Elderly (CAPE)] and personal socio-demographic variables in predicting the outcome of psychogeriatric day care. Two groups of elderly patients referred for day care were investigated: 40 new admissions to a psychogeriatric day centre and 63 new admissions to psychogeriatric day hospitals. Discriminant function analysis was employed to compare the classification accuracy obtained from the personal socio-demographic variables and the CAPE psychometric data. The results demonstrated the incremental validity of the CAPE in predicting outcome of day care in both settings and support the routine use of such brief measures as appropriate screening procedures in these settings.

Family attitudes to caring for the elderly mentally infirm at home.

Attitudes towards care-giving were examined in a sample of 129 supporters of elderly mentally infirm patients referred for psychogeriatric day care. As in previous studies, spouses felt more commitment to care-giving than other relatives. Commitment to care-giving was influenced by different factors in adult children and spouses, but consistently predicted subsequent decisions to institutionalize the dependant. Following institutionalization, most supporters felt relieved. They tended to perceive the decision to have been made by others, and to have resulted from a deterioration in their dependents' mental condition, rather than a failure of the care-giving relationship.

An Active Occupational Therapy Programme for the Severely Demented Patient in a Psychogeriatric Day Hospital

This article describes how an alternative occupational therapy programme has been devised for a group of severely demented patients attending Roborough Day Hospital, Eastbourne. The introduction of the programme has resulted in more care and attention being given to this group of patients and also in an improved level of job satisfaction for the occupational therapy staff concerned. The initiative for the innovation came from the occupational therapy helpers, who are responsible for its planning and implementation. The occupational therapist's role has been to monitor the work and give advice and support when necessary.

Impact of psychogeriatric day hospital care on the patient's family.

The supporters of 129 patients referred for psychogeriatric day hospital care were interviewed and followed-up after three and six months. The majority of their dependents suffered from dementia. Thirty-one per cent were still attending six months later, while 37% had been admitted to institutional care. The most positive effects of day hospital were associated with continued patient attendance, the number of distinct advantages foreseen by the supporter, and the lack of any negative expectations concerning their dependents' adjustment to day care. Positive benefits were also closely associated with reductions in the number of problems faced by the supporter.

Problems posed for supporting relatives of geriatric and psychogeriatric day patients.

Relatives of patients attending geriatric and psychogeriatric day hospitals throughout Scotland were asked to provide details of the problems they experienced looking after their elderly dependent. They also completed Goldberg's General Health Questionnaire (GHQ), to provide an index of degree of emotional disturbance. While differences emerged in the type of problems these two groups of supporters experienced with their dependent, the overall prevalence of emotional disturbance was high in both groups. Implications for the service provided by both types of day hospital are discussed.

The Continuum of Care Within Psychogeriatric Day Programming

Day programs represent an increasingly important component in treatment for the elderly. Several attempts have been made to categorize the wide variety of such programs but little attempt has been made to analyze the dynamic rather than static nature of such program design. Dalton's model of induced change is tested and illustrated through application to a psychogeriatric day program. Some of the reasons for the evolution which took place in the program included realization of the incrcased need to serve long-term chronic psychiatric clients, staffing changes, heterogeneity of clientele, change in availability of alternate resources in the community. The advantages of program flexibility in a developing area such as day care are discussed.

Patient Turnover in a new Psychogeriatric Day Hospital: a Pluralistic Evaluation

ABSTRACTStudies designed to evaluate the services of a health or welfare institution face the major difficulty of selecting evaluative criteria to serve as measures of successful performance. This paper explores that difficulty in the context of a study of a new psychogeriatric day hospital. The study and its methods of data collection are described. ‘Patient turnover’ features prominently as a measure of success within the hospital. Consultants, nurses, general practitioners, social workers, staff of a related hospital and patients’ relatives interpret this measure in different ways and adopt different strategies to pursue ‘success’ in their own interests. These differences are described. The paper concludes that a ‘pluralistic evaluation’ has several advantages as compared to other approaches.

Social Work and a Relatives Support Group in a Psychogeriatric Day Hospital: A Research Note

SUMMARY During the course of an evaluative study of a new psychogeriatric day hospital we encountered the fact that amongst the staff there is very widespread support, in general terms, for the importance of offering a service to the relatives of patients. A Relatives Group, in which the social worker attached to the hospital plays a leading role, is a major component of this service. However, the Group remains comparatively self-contained, is organised somewhat separately from the main body of hospital activities, and in practice systematic liaison with relatives has not formed any major part in the planning and design of the organisation as a whole. Apart from the Relatives Support Group, there are only a small number of occasions on which relatives have any regular contact with hospital staff. In this note we shall summarise our research which describes the nature of social events which are encompassed within the Group meetings. The research concludes that the Relatives Support Group sustains an ideology of service to relatives while confining many of the practical tasks so entailed to an organisational locale which limits the degree of 'relatives disturbance' to the rest of the institution. An implication of this thesis for social work in medicine is that, in so far as social workers play a significant part in running such groups, their attempts to introduce relatives in this way as significant consumers may, ironically, serve only to limit the impact of this group within the system of medical care.