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Psychiatric Consultation in Long-Term Care

A Guide for Health Care Professionals

Abhilash K. Desai, M.D., FAPA, and George T. Grossberg, M.D.

Publication Year: 2010

Studies show that residents of nursing homes and assisted living facilities are at a substantial risk of having psychiatric disorders. This practical volume provides much-needed clinical guidance for the prevention and appropriate treatment of mental illness in long-term care settings. Abhilash K. Desai and George T. Grossberg offer a basic framework for a humanistic, team-based approach to meeting the needs of elder persons with mental disorders in long-term care facilities. Early chapters cover the demographics of residents, the epidemiology of their psychiatric symptoms, and the assessment process. Subsequent chapters focus on major disorders, including dementia, delirium, depression, psychosis, and anxiety. The authors discuss end-of-life issues and treatments and offer suggestions for improving care. Throughout, they highlight the importance of the relationship between staff and residents. Emphasizing creative engagement and hands-on care and featuring clinical vignettes and practical tips, this optimistic volume reinforces the potential for nursing homes and assisted living facilities to be communities where residents thrive.

Published by: The Johns Hopkins University Press


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p. C-C

Title Page, Copyright Page

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pp. i-iv


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pp. v-vi

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pp. vii-x

A coauthored text such as this, unlike edited texts, gives the authors a unique opportunity to present state-of-the-art information regarding biopsychosocial and environmental interventions in long-term care (LTC) together 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...

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1 Introduction and Epidemiology

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pp. 1-15

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 prevent, 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 ...

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2 The Assessment Process

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pp. 16-49

Regular screening, comprehensive assessment, and evidencebased, state-of-the-science treatment of mental disorders are central to highquality care of residents in a long-term care facility. A comprehensive assessment process for initial evaluation involves a thorough history (from the resident, the family, and professional caregivers and by reviewing previous...

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3 Dementia

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pp. 50-105

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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4 Delirium

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pp. 106-122

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 ...

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5 Mood Disorders

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pp. 123-162

Mood disorders (especially depression) are the second most common 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...

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6 Psychotic Disorders

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pp. 163-188

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 behaviors may also be evidence of impaired reality testing. Delusions are false, unshakeable beliefs that are not in keeping with the person’s cultural beliefs....

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7 Anxiety Disorders and Sleep Disorders

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pp. 189-217

Anxiety and sleep disorders are common among residents in longterm care facilities, cause significant emotional distress to residents, increase family and caregiver stress, and may be associated with an increased risk of falls, injury, hospitalization, and excess disability....

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8 Personality Disorders, Somatoform Disorders, Substance Use Disorders, and Other Psychiatric Disorders

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pp. 218-227

In the differential diagnosis of behavioral and psychological symptoms in long-term care populations (including comorbidity with more prevalent psychiatric disorders [e.g., dementia, depression, and anxiety disorders]), psychiatric disorders that clinicians need to consider include personality disorders,...

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9 Psychiatric Aspects of Nutritional Disorders, Frailty, and Failure to Thrive

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pp. 228-251

Nutritional disorders, frailty, and failure to thrive are highly prevalent 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 treatable....

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10 Abuse and Neglect, Ethical Dilemmas, and Medicolegal Issues

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pp. 252-266

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 longterm 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...

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11 Palliative and End-of-Life Care

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pp. 267-295

Death and dying are central features of any practice in long-term care. The most common causes of death in long-term care populations include 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 ...

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12 Pharmacological Interventions

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pp. 296-348

Pharmacological interventions are the primary treatments for many medical (e.g., moderate to severe pain) and psychiatric disorders (e.g., schizophrenia, bipolar disorder, recurrent MDD). Evidence-based pharmacological interventions, when used judiciously, have the potential to substantially improve the quality of life for many residents in long-term care facilities ...

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13 Psychosocial and Environmental Interventions

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pp. 349-401

Psychosocial and environmental interventions are the primary mode of treatment for behavioral and psychological symptoms in the majority of long-term care populations (Morley 2008). Not only are psychosocial-environmental interventions effective for treating behavioral and psychological symptoms, but pharmacological interventions are associated with significant...

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14 An Ideal Long-Term Care Home

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pp. 402-420

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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pp. 421-424


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pp. 425-430


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pp. 431-462


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pp. 463-476

About the Authors

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p. 477-477

E-ISBN-13: 9781421409214
E-ISBN-10: 1421409216
Print-ISBN-13: 9780801893865
Print-ISBN-10: 0801893860

Page Count: 488
Publication Year: 2010