Psychiatric Consultation in Long-Term Care
A Guide for Health Care Professionals
Publication Year: 2010
Published by: The Johns Hopkins University Press
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Title Page, Copyright Page
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A coauthored text such as this, unlike edited texts, gives the au-thors a unique opportunity to present state-of-the-art information regarding biopsychosocial and environmental interventions in long-term care (LTC) to-gether with our philosophy of caring for older adults who live in LTC settings. Our philosophy of care is that “there is life in the nursing home” and other ...
1 Introduction and Epidemiology
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Long-term care (LTC) is one of the fastest-growing segments of health care in the United States and is an important setting in which to pre-vent, identify, and treat behavioral and psychological symptoms the residents experience. LTC facilities include both nursing homes and alternatives to nursing homes (primarily assisted living facilities). The spectrum of LTC also ...
2 The Assessment Process
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...based, state-of-the-science treatment of mental disorders are central to high-quality care of residents in a long-term care facility. A comprehensive as-sessment process for initial evaluation involves a thorough history (from the resident, the family, and professional caregivers and by reviewing previous records); pertinent physical and neurological exams; a detailed mental sta-...
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Dementia is a progressive impairment in cognition and the ability to reason, which substantially interferes with one’s abilities to perform daily activities and live independently and may eventually cause death. Cognition is a combination of skills, including attention, learning, memory, language, praxis, recognition, and executive functions such as decision making, goal ...
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Delirium is a classic geriatric psychiatric syndrome that occurs commonly among elderly people who are frail or have dementia, that is, those who make up most of the residents in a long-term care facility (Inouye 2006; Eeles and Rockwood 2008). When screened, up to 15 percent of the people admitted to a postacute facility are delirious (Kiely et al. 2003). Among LTC ...
5 Mood Disorders
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Mood disorders (especially depression) are the second most com-mon psychiatric disorder (after dementia) for residents in long-term care facilities (Mulsant and Ganguli 1999; Payne et al. 2002). Mood disorders often impede compliance with medical treatment, a response to analgesics, activities of daily living (e.g., bathing, dressing, feeding, toileting), and reha-...
6 Psychotic Disorders
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Psychotic disorders are serious psychiatric conditions because of their clinical significance and social impact. Delusions and hallucinations are the hallmarks of psychotic disorders, although catatonic and bizarre be-haviors may also be evidence of impaired reality testing. Delusions are false, unshakeable beliefs that are not in keeping with the person’s cultural beliefs. ...
7 Anxiety Disorders and Sleep Disorders
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Anxiety and sleep disorders are common among residents in long-term care facilities, cause significant emotional distress to residents, increase family and caregiver stress, and may be associated with an increased risk of Anxiety is defined as a vague, uneasy feeling, the source of which often is nonspecific or unknown to the individual who is experiencing it. Fear is anxi-...
8 Personality Disorders, Somatoform Disorders, Substance Use Disorders, and Other Psychiatric Disorders
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In the differential diagnosis of behavioral and psychological symp-toms in long-term care populations (including comorbidity with more preva-lent psychiatric disorders [e.g., dementia, depression, and anxiety disorders]), psychiatric disorders that clinicians need to consider include personality dis-orders, somatoform disorders, substance use disorders, impulse control disor-...
9 Psychiatric Aspects of Nutritional Disorders, Frailty, and Failure to Thrive
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Nutritional disorders, frailty, and failure to thrive are highly preva-lent medical conditions in long-term care populations, and their prevalence is even higher in LTC populations with psychiatric disorders (e.g., dementia, depression, or delirium) (Robertson and Montagnini 2004; P. Thomas et al. 2004; Morley et al. 2006). Fortunately, these disorders are eminently treat-...
10 Abuse and Neglect, Ethical Dilemmas, and Medicolegal Issues
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Old age is an authentic period of life, and integrating the unity of one’s life is one of the tasks of old age. The majority of the residents in long-term care facilities are weak and diminished due to multiple medical and psychiatric disorders and thus need help to achieve this integrating task. All health care providers should strive to keep our elderly people in caring LTC ...
11 Palliative and End-of-Life Care
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Death and dying are central features of any practice in long-term care. The most common causes of death in long-term care populations in-clude terminal-stage dementia, congestive heart failure, cancer, and strokes. In LTC populations that have underlying terminal conditions, pneumonia, cachexia, dehydration, and hip fractures are the most common acute medical ...
12 Pharmacological Interventions
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...many medical (e.g., moderate to severe pain) and psychiatric disorders (e.g., schizophrenia, bipolar disorder, recurrent MDD). Evidence-based pharmaco-logical interventions, when used judiciously, have the potential to substan-tially improve the quality of life for many residents in long-term care facilities who are experiencing significant and persistent behavioral and psychological ...
13 Psychosocial and Environmental Interventions
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...mode of treatment for behavioral and psychological symptoms in the majority of long-term care populations (Morley 2008). Not only are psychosocial-en-vironmental interventions effective for treating behavioral and psychological symptoms, but pharmacological interventions are associated with significant adverse effects and are often ineffective because they do not address the most ...
14 An Ideal Long-Term Care Home
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Visionary and determined people are reinventing long-term care facilities. These individuals believe that each of us, no matter how old, sick, frail, disabled, or forgetful, deserves to have a loving home—not a facility. These individuals have pioneered LTC homes to replace LTC facilities. Such LTC homes make the quality of life for their residents life affirming, create ...
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Rabins, P. V., D. Blacker, B. W. Rovner, et al. 2007. Practice Guidelines for the Treatment of Patients with Alzheimer’s Disease and Other Dementias, 2nd ed. Arlington, VA: American Psychiatric www.amda.com: The Web site of the American Medical Directors Association, the organization of medical directors of nursing homes. Various clinical practice guidelines for the assessment and treatment of common clinical syndromes (e.g., depression, pain, falls, delirium, behav-...
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About the Authors
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Abhilash K. Desai, M.D., is associate professor and director of the Center for Healthy Brain Aging in the Division of Geriatric Psychiatry, Department of Neurology and Psychiatry, at Saint Louis University School of Medicine in Saint Louis, Missouri. He received an H.S.C. from Jaihind College and an M.D. from Seth G. S. Medical Col-From 2004 to 2008, Dr. Desai served as medical director of the Alzheimer’s Center ...
Page Count: 488
Publication Year: 2010