I’m excited to present Jason Young as a guest blogger this week. He and I met on Twitter and have developed a great professional rapport. He has extensive knowldege in the elder care arena and will be a speaker at our upcoming telesummit later this summer.
The Road Less Travelled; The Inpatient Geriatric-Psychiatric Option.
– Jason Young, MS
Making the decision to admit a loved one to a geriatric psychiatric unit can be extremely difficult and emotionally devastating for families. Unfortunately, those who never choose to make the difficult decision to do so can never feel the ecstatic relief and happiness from improvements that can come as a result of making such a commitment for change.
Caregivers often recognize the need of such treatment, though avoid admitting to themselves just how bad things have gotten. This avoidance often leads to worsening of problems that can be more easily resolved if the family follows their intuition as to what needs to occur. By learning more about common treatment scenarios at psych units, one can be more prepared to make an informed decision if faced with needing such assistance.
When a geriatric patient begins to experience a substantial decrease in appetite and sleep, this can quickly become a life threatening situation. For example, someone diagnosed with Major Depression showing a sudden decrease in appetite may benefit greatly from an evaluation of their antidepressant medications. Often, specialists are able to prescribe medications that have strong appetite stimulating properties in addition to their psychotropic effects.
The person diagnosed with Alzheimer’s Disease doing fairly well for a few years may begin to become more agitated and uncooperative with care, sometimes refusing medications. If the complete refusal of medications continues for long, numerous complications can occur. Many times, adjustments can be made to memory enhancing meds and anti-psychotics that can be of great help. Other times there is untreated depression and / or anxiety that can be addressed accordingly.
The aforementioned examples certainly do not encompass the hundreds of differing treatment scenarios that occur. Though by considering the positive results that can be reached in a short amount of time within an intensive psychiatric program, one can conceptualize how such an approach may be able to help their loved one. Acute intensive psychiatric treatment should be thought of as the option to take when ones primary physician and / or psychiatrist has been unable to stabilize the patient on an outpatient basis. The only reason to seek treatment at an inpatient unit is to allow a specialist the opportunity to evaluate the patient for needed changes to their medications. This is certainly not the only advantage of entering such a facility, though it is the primary goal that should never be lost sight of. Great things happen in these facilities. All caregivers of elderly persons with cognitive problems should become more knowledgeable on where their loved one could obtain such help should it ever be needed.
Jason has 10 years experience with serving seniors in several capacities. He currently works as a geriatric clinician, marketer, and speaker for a health care company and geriatric inpatient psychiatric unit. Jason has a Bachelors Degree in Social Work and a Masters in Community Agency Counseling. For more of his articles, please visit http://jasonyoung99.wordpress.com.
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Jason,
Can you comment a bit on conditions that would prohibit the person from being admitted when a caregiver/family member and primary care doctor thought such a placement was needed?
I just read ElderRage by Marcell. In it, she talks about her father being denied entry to a psychiatric facility because he had “labile” moods, and the facility could not risk her father getting violent with other patients. But, isn’t such behavior a symptom of Alzheimer’s?
from Jason:
Your question is an excellent one. I would be glad to address it.
Many things can get in the way of an admission to a unit. First, I must distinguish between two types of geriatric psychiatric units. There are voluntary and involuntary units. The unit that I work within is a voluntary unit. This means that the person acting as medical power of attorney is giving consent for someone to be admitted (not necessarily that the patient is voluntarily coming in to unit). Involuntary units handle commitment cases that entail legal processes in court to admit someone.
I would question seriously the clinical decision of an institution not accepting someone based on “labile” moods. The fact that someone’s mood is unstable is most likely related to disease symptoms and should not be a reason for denial in itself.
The issue of “violent behavior” is a gray area that demands a little more discussion. Because of the fact that admission ages often begin around 60-65 years of age, there can be a wide spectrum of ages and physical strengths among even those common to the “geriatric” group. The person that is assessing patients for admission must take into consideration the current group of people on the unit and how the new admission will fit into the group. If there are multiple physically aggressive type patients on the unit at the time another aggressive patient is being assessed, it is actually a BETTER time for that patient to be admitted often times because of the fact that the unit is probably being staffed with more nurses and technicians who can monitor behaviors more easily. If a group is primarily 80-90 year old patients being treated for Alzheimers type anxiety and a 66 year old person is referred to the unit for aggressive behavior that is often unprovoked, this is a time that the person may be denied treatment. The admissions staff, in my opinion, must consider the safety of the entire group and make the best decision possible considering current factors at hand.
The above situation is outlining worst case scenarios as to why a person may be denied. Units should generally be able to handle the types of behaviors you described because they ARE symptoms of the disease.
Unfortunately, there may have been other motives such as other patients being assessed and gaining priority over this patient.
Lack of power of attorney is the biggest problem where I work. Families do not have to have a power of attorney drawn up at a law office, though they do need at least a medical surrogate appointed by the patient. This of course varies from state to state.