Psychogeriatric Wards Research Articles

Daily (In)Activities of Nursing Home Residents in Their Wards: An Observation Study

ObjectivesResearch shows that nursing home residents are largely inactive. This inactivity negatively influences physical fitness, and participation in daily activities is known to have a positive influence on physical function and quality of life. Existing research does not provide sufficient insight into the daily activities in which nursing home residents participate. This insight is needed to develop future interventions so as to encourage nursing home residents to participate in daily activities and, thereby, decrease inactivity. The purpose of this study was to obtain insight into daily (in)activities of psychogeriatric and somatic nursing home residents during the day and their body positions during these (in)activities. DesignCross-sectional observation study. SettingNursing homes in the Netherlands (19 psychogeriatric and 11 somatic wards). ParticipantsParticipants were 723 home residents in 7 nursing homes. MeasurementsObservations were conducted using a self-developed observation list. Residents were observed in their wards during 5 random observation times between 7:00 am and 11:00 pm, in which the daily activity and position of the resident during this activity were scored. Percentages of activities and positions were calculated for each observation time. ResultsIn total, 3282 observations (91% of the intended 3615 observations) were conducted. Nursing home residents of both psychogeriatric and somatic wards were mainly observed partaking in inactivities, such as sleeping, doing nothing, and watching TV (range: 45%–77% of the 5 observation times). Furthermore, residents were engaged in activities of daily living (ADLs) (range: 15%–38%) that mainly comprised activities related to mobility (range: 10%–19%) and eating and drinking (range: 2%–17%). Engagement of residents in instrumental ADLs (IADLs) was rarely observed (up to 3%). Residents were largely observed in a lying or sitting position (range: 89%–92%). ConclusionMost of the psychogeriatric and somatic nursing home residents spend their day inactive in a lying or sitting position in the ward. To encourage nursing home residents in daily activities in the wards, interventions are needed that (1) focus on increasing ADLs and IADLs, and (2) encourage standing and walking.

A retrospective study of medical comorbidities in psychogeriatric patients.

This study contributes further research into the assessment and treatment of older psychiatric patients with medical comorbidities. A retrospective file audit was conducted at the acute inpatient psychogeriatric unit of St Vincent's Aged Mental Health Service, Melbourne, in order to determine the prevalence of certain medical comorbidities and the nature of medical interventions provided for psychogeriatric inpatients. This study, investigating 165 admissions into an acute inpatient psychogeriatric unit, highlights that psychiatric and medical comorbidities are routine in this population: the vast majority (91.5%) of all inpatients had at least one medical comorbidity. As the population ages, psychogeriatric wards are likely to see more of the oldest-olds, who are likely to have comorbid medical illnesses. Currently, appropriate detection, investigation, and management of these illnesses are often suboptimal and can affect quality of life, increase mortality, and complicate treatment. This paper adds to the literature about the need for integrating medical and psychiatric care to create a more comprehensive strategy for treating the older person with psychiatric illness.

Catatonia in Patients with Frontotemporal Dementia

Introduction Catatonia is a neuropsychiatric syndrome described in a variety of medical and psychiatric conditions. Its association with frontotemporal dementia (FTD) has been sparsely described. Objetives We reported two patients with FTD that present a catatonic state. Aim Case reports Method Literature review through Pubmed and report of a clinical cases. Results Case 1: Frontotemporal dementia, behavioral variant. 65 year old female who was hospitalized after losing weight due to his active refusal to eat and subsequently was undergone a gastrostomy. Once stabilized physically was derived to psychogeriatric ward where the patient was stuporous, mute, with mannerisms and rigidity. Continued with refusal to take food. On examination she had staring, posturing, echophenomena, automatic obedience, Gegenhalten, ambitendency and perseveration. It featured 12 of 23 symptoms of Bush and Francis Catatonia Rating Scale (BFCRS), scoring 32. She improved completely her catatonic state within one week with lorazepam 2.5 mg /day and zolpidem 10mg/day. Perseverative behavior and mannerisms was maintained. Case 2: Frontotemporal dementia, primary progressive aphasia 67 years old male who was admitted to psychogeriatric ward because had aggressivity and negativism. On examination immobility, mutism, staring, echolalia, rigidity, negativism, withdrawal, perseveration, Gegenhalten, impulsiveness and combativeness were observed. It featured 11 of 23 symptoms of BFCRS, scoring 22. He was treated with lorazepam 10mg/day and valproic acid 900 mg/day. Catatonic symptoms disappeared a month later. Negativism and impulsiveness persisted slightly. Conclusions The catatonic syndrome may occur in patients with FTD. In both conditions symptoms overlap. The response to GABAergic drugs was optimal.

P270: Factors associated with fall rate in psychogeriatric residents

Introduction: Falls in psychogeriatric residents represent a costly but unresolved safety issue. Identifying fall risk factors and their inter-relationship may help to individualize prevention programs and increase the effectiveness. Therefore, we aimed to examine the relationship between patient characteristics and fall rate in psychogeriatric residents. Methods: Twenty nursing home residents with dementia (80±11 years; 60% male) living on a psychogeriatric ward participated. Based on patient records, we identified 66 patient characteristics and extracted the number of falls over 19 months. Patient characteristics represented seven domains: demographics, ADL, mobility, cognition and behaviour, vision and hearing, medical conditions, and drug-use. We evaluated the relationship between patient characteristics and fall rate using multivariate Partial Least Squares regression. Results: A total of 115 falls (5.1±6.7 falls/person year) occurred during the study period. The 66 patient characteristics included in the model explained 96% of the variance in fall rate. Reduced mobility abilities, indicators of disinhibited behavior, diabetes, and use of analgesics, beta blocking agents and psycholeptics were positively associated with fall rate. Whereas immobility, heart failure, and the inability to communicate were negatively associated fall rate. Conclusion: Dementia is often indicated as fall risk factor; however, our results showed that especially cognitive impairment related to disinhibited behaviour was associated with a high fall rate in psychogeriatric residents. Furthermore, immobility and inactivity seemed to decrease fall rate. The analytic approach provided a detailed view of the fall risk factors and their interactions in psychogeriatric residents, enabling more effective fall prevention.

Effects of small-scale, home-like facilities in dementia care on residents’ behavior, and use of physical restraints and psychotropic drugs: a quasi-experimental study

Small-scale, home-like care environments are increasingly implemented in institutional nursing care as a model to promote resident-directed care, although evidence on its effects is sparse. This study focuses on the effects of small-scale living facilities on the behavior of residents with dementia and use of physical restraints and psychotropic drugs. A quasi-experimental study was conducted comparing residents in two types of long-term institutional nursing care (i.e., small-scale living facilities and traditional psychogeriatric wards) on three time points: at baseline and follow-ups after six and 12 months. Residents were matched at baseline on cognitive and functional status to increase comparability of groups at baseline. Nurses assessed neuropsychiatric and depressive symptoms, agitation, social engagement, and use of physical restraints using questionnaires. Psychotropic drug use was derived from residents' medical records. In total, 259 residents were included: 124 in small-scale living facilities and 135 controls. Significantly fewer physical restraints and psychotropic drugs were used in small-scale living facilities compared with traditional wards. Residents in small-scale living facilities were significantly more socially engaged, at baseline and after six months follow-up, and displayed more physically non-aggressive behavior after 12 months than residents in traditional wards. No other differences were found. This study suggests positive effects of small-scale living facilities on the use of physical restraints and psychotropic drugs. However, the results for behavior were mixed. More research is needed to gain an insight on the relationship between dementia care environment and other residents' outcomes.

Psychoterapia pacjentów depresyjnych w starszym wieku stosowana w oddziale stacjonarnym i dziennym psychogeriatrycznym

Streszczenie: Psychoterapia osób starszych wydaje się być bardzo ważnym elementem kompleksowego leczenia, a jej charakter powinien być oparty o holistyczną wizję człowieka. W literaturze przedmiotu najlepiej udokumentowana jest skuteczność indywidualnej psychoterapii poznawczo-behawioralnej i terapii skoncentrowanej na rozwiązaniach problemu. W leczeniu pacjentów w oddziale psychogeriatrycznym, ze względu na opisany w artykule złożony obraz kliniczny, psychoterapia ma przede wszystkim charakter wspierający, z uwzględnieniem podejścia egzystencjalnego. Ważnym elementem pracy terapeutycznej jest całościowe podejście do potrzeb pacjenta, próba rozumienia konfliktów wewnętrznych, nastawienie na terapię długofalową oraz stawianie realnych celów dostosowanych do możliwości pacjenta. Zmiana myślenia u pacjentów może zaowocować wieloma przemianami w codziennym życiu, funkcjonowaniu i relacjach z innymi ludźmi. Wydaje się, że u osób starszych wybór metody psychoterapeutycznej należy dostosować indywidualnie do obrazu klinicznego, gotowości do pracy terapeutycznej i sytuacji życiowej pacjenta. W artykule tym autorzy dzielą się własnymi doświadczeniami i refleksjami ze stosowania psychoterapii indywidualnej i grupowej u pacjentów w podeszłym wieku w oddziale psychogeriatrycznym stacjonarnym i dziennym.

Non-adherence in seniors with dementia - a serious problem of routine clinical practice.

Non-adherence to treatment in seniors with dementia is a frequent and potentially dangerous phenomenon in routine clinical practice which might lead to the inappropriate treatment of a patient, including the risk of intoxication. There might be different causes of non-adherence in patients with dementia: memory impairment, sensory disturbances, limitations in mobility, economical reasons limiting access to health care and medication. Non-adherence leads to serious clinical consequences as well as being a challenge for public health. to estimate prevalence of non-adherence in seniors with dementia and to study correlation between cognitive decline and non-adherence. Prospective study, analyzing medical records of seniors with dementia admitted to the inpatient psychogeriatric ward in the Kromeriz mental hospital from January 2010 to January 2011. Cognitive decline measured by MMSE, prevalence of Non-adherence to treatment and reasons for patient Non-adherence were studied. Non-adherence to any treatment was detected in 31.3% of seniors; memory impairment was the most common cause of non-adherence to treatment. In conclusion, non-adherence to treatment in the studied group of seniors with dementia correlates with the severity of cognitive impairment - a higher cognitive decline correlates with a higher risk of non-adherence to treatment.

Forming Life: Aesthetic Awareness in Mental Health Care

Using cross-disciplinary perspectives from artistic research, aesthetic theory, and mental health care, this article discusses qualities in sensuous surroundings in mental health facilities. Although the background for the article is in the increased awareness in aesthetic research concerning sensuous surroundings and their connection to health and well-being, this aesthetic research is only reflected to a small extent in research on mental health care surroundings. A further development of these perspectives is suggested in this article by introducing the concept of life forms from the art theorist Nicolas Bourriaud and the concepts of presentation and perception in theatrical communication from theatre researcher Willmar Sauter. These theories are discussed and exemplified on the basis of data from two mental health care wards: one from a psychogeriatric ward and the other from a polyclinic for eating disorders. Some essential qualities identified in the examples were that aesthetic environment and activity could be seen as formative to the “inner landscape”, and that different forms of sensuous activation and interaction could help patients escape communicative isolation. It is further demonstrated how participatory strategies can challenge artistic practice and that art can contribute to a health promoting and communicative space in mental health care. In the discussion section, it is argued that an activating, and possibly empowering, environment can be created through an increased awareness of the aesthetic strategies used in health care institutions. The study seeks to contribute to knowledge transfer in artistic practice and healthcare practice, as a part of a cross-disciplinary art didactic discourse, which intends to address specific societal challenges.

Basiszorg in het verpleeghuis: longitudinale weergave van zorgproblemen gemeten door de Landelijke Prevalentiemeting Zorgproblemen

Since 1998, the National Prevalence Measurement of Care Problems (LPZ) has annually measured the prevalence, prevention and treatment of a number of care problems in many health care organisations. These problems include pressure ulcers, incontinence, intertrigo, malnutrition, falls and the use of restraints. This article describes trends in the prevalence of these problems during the past few years and the preventive and treatment measures taken for clients residing in psychogeriatric and/or somatic wards of nursing homes. The results show that the prevalence of these care problems has declined in general. Nevertheless, the individual interventions (preventive measures and treatment) have not really changed in recent years. It is concluded that the extra attention paid to these care problems might already have had a positive effect on their prevalence. This must be further investigated. In any case, extra follow-up steps need to be taken to bring about a further decline. The article describes which steps the project group has already taken in this respect.

Kleinschalig wonen voor ouderen met dementie: de invloed op bewoners, mantelzorgers en medewerkers

Institutional dementia care is increasingly directed towards small-scale and homelike care environments, in The Netherlands as well as abroad. In these facilities, a small number of residents, usually six to eight, live together, and normal daily household activities and social participation are emphasized. In a quasi-experimental study, we studied the effects of small-scale, homelike care environments on residents (n = 259), family caregivers (n = 206) and nursing staff (n = 305). We compared two types of institutional nursing care during a 1 year period (baseline assessment and follow-up measurements at 6 and 12 months): (28) small-scale, homelike care environments and (21) psychogeriatric wards in traditional nursing homes. A matching procedure was applied to increase comparability of residents at baseline regarding functional status and cognition. This study was unable to demonstrate convincing overall effects of small-scale, homelike care facilities. On our primary outcome measures, such as quality of life and behaviour of residents and job satisfaction and motivation of nursing staff, no differences were found with traditional nursing homes. We conclude that small-scale, homelike care environments are not necessarily a better care environment than regular nursing homes and other types of living arrangements should be considered carefully. This provides opportunities for residents and their family caregivers to make a choice which care facility suits their wishes and beliefs best.

The role of wrist actigraphy in the evaluation and safety of patients in psychogeriatric ward

The role of wrist actigraphy in the evaluation and safety of patients in psychogeriatric ward

Predictors of Time to Discharge in Patients Hospitalized for Behavioral and Psychological Symptoms of Dementia

Background/Aims: In Japan, more than 50,000 patients with dementia are housed in psychiatric facilities, a trend precipitated by prolonged hospitalizations. This study aimed to determine predictors for the time to discharge in patients hospitalized for behavioral and psychological symptoms of dementia (BPSD). Methods: Medical charts of patients admitted to an acute psychogeriatric ward for treatment of BPSD were reviewed. Cox's proportional hazards model was used to evaluate relationships between active behavioral problems and/or demographics at the time of admission, and the time until favorable discharge (FD), defined as discharge to the patient's own home or a care facility. Results: For the 402 study patients included in this study, median time to FD was 101 days. In addition to family and residential factors, multivariate analysis identified higher Mini-Mental State Examination scores as independent clinical predictors for a shorter hospital stay, whereas male gender and combative behavior as the primary reason for hospital admission were predictors for a longer hospital stay. Conclusion: Clinical characteristics can be predictive of the time to discharge for patients with BPSD. Earlier interventions and enhanced care strategies may be needed for patients with a lower likelihood of FD.

524 – Karnofsky index and apache II score in severe dementia

Introduction Karnofsky score is used in oncology and APACHE II score in critical care to estimate prognosis of patients with severe health conditions. In psychogeriatric palliative care such indicators are still missing althought it can be usefull to have such instrument. Objectives, aims To determine whether Karnofsky score and APACHE II score can be also used in psychogeriatry. Methods Prospective study done in 2011 in psychogeriatric wards, Mental hospital Kromeriz. Karnofsky score and APACHE II score were measured in patients with severe dementia (MMSE bellow 6) at the beginning of the hospitalisation. Lethality was prospectively followed in relation to Karnofsky score and APACHE II score. Results Correlation between Karnofsky score, APACHE II and lethality in patients with severe dementia was strong (r = 0.64 for Karnofsky score, r = 0.72). Conclusion Both Karnofsky score and APACHE II score can be used in psychogeriatry as well to estimate prognosis in patients with severe dementia.

521 – Serotoninergic antidepressants and anticoagulants in psychogeriatric wards, mental hospital kromeriz, czech republic - what shall we do to prevent from serious drug interactions?

Introduction Both serotoninergic antidepressants and anticoagulants are widely udes in psychogeriatry. These drugs can develop drug interactions with subsequent risk of bleeding. Objectives, aims To determine risk of potential drug interactions between serotoninergic antidepressants and anticoagulants serotoninergic antidepressants and anticoagulants with subsequent risk of bleeding. Methods Retrospective analysis of medical records and laboratory checks (INR values) in senior patients treated with serotoninergic antidepressants and anticoagulants (Mental hospital Kromeriz, Czech republic, year 2011). Results In 15.5% of patients treated with combination serotoninergic antidepressant / anticoagulant the dosage of anticoagulant had to be decreased due to unwanted elevation of INR value. In 0.6% of patients the risk of bleeding was clinically evident. Conclusion Serotoninergic antidepressants and anticoagulants are common drugs used in treating seniors with mental disorder and potential drug interactions between them should be taken into account.

453 – A pilot study on a collaborative education program between psychogeriatric ward and community psychiatric service for caregivers of suicidal elderly

Caregivers experience great stress when their old relatives have attempted suicide, are diagnosed with depression and are discharged after hospitalization. The stress is partly induced by the lack of elderly suicidal precaution knowledge and skills. Actually, caregivers need support during and particularly, after patients’ hospitalization. A collaborative education program is conducted for those caregivers during and after patients’ hospitalization. Objectives The pilot study aimed to evaluate the effectiveness of a collaborative education program in term of feedbacks from community suicidal precaution nurses (CSPN) and caregivers. Method A convenience sample of eight caregivers of patients who presented with suicidal idea or attempted suicide before current admission, and were diagnosed with depression in a study ward were recruited. Knowledge and theory about elderly suicide and caring skill were taught by the psycho-geriatric ward nurse during patient hospitalization. When patient was discharged, the CSPN were liaised. They would help caregivers transforming the theory into practice at their home, and then reinforce their suicidal precaution skills. The effectiveness of the collaborative education program was evaluated by feedbacks from CSPN and caregivers. Results The CSPN agreed that the collaborative program was useful and practical, which bridged caregivers’ knowledge gap. The program provided a continuous support to caregivers before and after patients’ discharge. The caregivers expressed that the program was satisfactory and met their needs. Conclusion The collaborative program was effective in providing continuous support on practicing the suicidal precaution skill among the caregivers.

519 – Nonpharmacological approaches to treatment of cognitive functions in patiens with mild and moderate dementia

Introduction Dementia is severe mental disorder which should be treated both with pharmacological and nonpharmacological approaches. Objectives, aims To evaluate the effectiveness of non-pharmacological approaches influencing cognitive functions we used in routine practice in inpatient women psychogeriatric ward in Mental hospital in Kromeriz and satisfaction with these activities in hospitalised patients. Methods At the beginning and at the end of hospitalisation was used range of Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) to make an indicative assessment of cognitive functions, and at the end of hospitalization was used a controlled interview. Results At the end of hospitalisation there was no significant evidence of improving cognitive functions (short period of research is the most probable reason). Nevertheless, psychotherapeutic activities were evaluated by clients positively. Conclusion Non-pharmacological approaches have important position in treatment of dementia, together with pharmacological and support therapy.

Pastoral care in old age psychiatry: Addressing the spiritual needs of inpatients in an acute aged mental health unit

Pastoral Care (PC) practitioners respond to the spiritual needs of patients and families of all spiritual orientations. The integrated PC service in an acute psychogeriatric inpatient ward at St Vincent's Aged Mental Health Service, Melbourne, Australia, was examined to investigate how PC was being accessed by inpatients. A retrospective medical record file audit was undertaken of patients admitted over a 16-month period from 1 February 2009 to 30 June 30 2010 (n = 202). Sixty-eight percent were seen by PC practitioners during their admission. Sixty-six percent received PC assessments, 32% received PC ministry, and 10% received PC ritual or worship interventions. Other interventions (counseling/education, crisis situation, grief/ bereavement counseling) occurred infrequently. Seventy-five percent of Roman Catholic patients received PC compared to 57% of those patients with no religious affiliation. However, the overall association between religious grouping and receiving PC was not significant. Gender, religion, marital status, legal status, country of birth, language spoken, living situation, carer needs, or educational level were not related to PC contact. Whether or not an inpatient received PC assessment was unrelated to diagnostic category. Patients seen by PC were significantly more likely to engage in religious practice, have longer length of stay, and have neuropsychological, social work and occupational therapy assessments. Results suggest that PC practitioners can help optimize the clinical care of patients by developing a comprehensive understanding of their spiritual and religious needs and providing a more holistic service.

Prevalence and Spread of Multidrug Resistant Escherichia coli Isolates Among Nursing Home Residents in the Southern Part of the Netherlands

Empiric antibiotic treatment should be based on recent surveillance data. Therefore, we conducted a surveillance of (multidrug) resistance of Escherichia coli and antibiotic use among Dutch nursing home (NH) residents. Pulsed-field gel electrophoresis and multilocus sequence typing were used to describe the spread of multidrug-resistant strains. Observational study. Five NHs in the southern part of The Netherlands. A total of 337 NH residents from both somatic and psychogeriatric wards. The prevalence and spread of antibiotic resistance and multidrug resistant E. coli isolates collected from urine samples and antibiotic use among the NH residents were investigated. A total of 208 E. coli isolates were collected from 308 urine samples. Resistance to amoxicillin-clavulanic acid was 23% and resistance to ciprofloxacin was 16%. Resistance to trimethoprim-sulfamethoxazole was 19%, whereas nitrofurantoin resistance was less than 1%. Multidrug resistance was observed in 28 of the 208 isolates (13%). Several isolates showed a similar pulsed-field gel electrophoresis pulsotype and multilocus sequence typing type. Sequence type (ST) 131 was the most prevalent (48%) and was demonstrated in all NHs and with four different pulsotypes. Consumption of antibiotics for systemic use was 64.4 defined daily dose (DDD)/1000 residents/day. Amoxicillin-clavulanic acid was most frequently prescribed (20.92 DDD/1000 residents/day), followed by the quinolones (14.8 DDD/1000 residents/day). We observed a high prevalence of antibiotic resistance and antibiotic use. In particular, the use of and resistance to fluoroquinolones is concerning. Because of the high prevalence of resistance, many agents are no longer suitable for empiric treatment. E. coli ST131, which has also been demonstrated in this study, poses a potential risk to this vulnerable population. We have clearly demonstrated that the resistance among NH residents is different from elderly living at home and hospitalized patients, and with the emergence of resistant strains, such as ST131, NHs are a potential reservoir for multidrug resistant bacteria.

Asenapine for elderly bipolar manic patients

BackgroundBipolar disorder (BPD) in the elderly is probably heterogeneous and its etiopathogenesis is complex. The data for the treatment of late-life BPD are limited. Asenapine is approved in the United States for acute treatment of manic or mixed episodes of bipolar I disorder with or without psychotic features. AimWe report the results of acute treatment with asenapine in elderly patients with BPD. MethodElderly patients (N=11), mean age: 67.7±6.1 years, consecutively admitted to the psychogeriatric ward due to acute bipolar mania were treated by asenapine 10mg/BID monotherapy for 4 weeks. Safety and tolerability assessments included adverse events (AEs), laboratory values, and anthropometric measures. Response, a secondary assessment, was measured as change in Young Mania Rating Scale (YMRS) total score from baseline to week 4. ResultsOne patient developed a rash on day 6 of treatment and one patient developed peripheral edema on day 14 of treatment. Both AEs resolved rapidly following discontinuation of asenapine. Only mild sedation was reported by three patients. In all cases, mean (±SD) change (improvement) in YMRS total score at week 4 was −21.4±12.9 and 7/11 (63.6%) of patients remitted (YMRS≤12). ConclusionIn this small open-label study of elderly patients with bipolar mania, acute treatment with asenapine was well tolerated and effective.

High morbidity and mortality associated with an outbreak of influenza A(H3N2) in a psycho-geriatric facility.

In spring 2008, an influenza A subtype H3N2 outbreak occurred in a long stay psycho-geriatric ward and two wards in the intellectual disability services (IDS), part of a large psychiatric hospital. The attack rate in the index ward was 90% (18/20) for patients and 35% (7/20) for staff. It was 14% (1/7) and 17% (2/12) in the affected IDS wards for patients and 0% (0/20) and 4% (1/25) for staff. Many of the laboratory-confirmed cases did not have a fever >38 °C, a typical sign of influenza. Control measures included oseltamivir treatment for cases and prophylaxis for contacts, standard and droplet infection control precautions, active surveillance for early detection and isolation of potential cases. As a result, the outbreak did not spread throughout the hospital. Although the staff vaccination rate (10%) prior to the outbreak was low, we observed a much lower vaccine effectiveness rate in the patients (11%) than in the staff (100%) in the index ward. Vaccination of residents and staff of such facilities remains the key influenza prevention strategy.