Psychiatry for older adults
A foolish challenge?
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Ronald Schmidt, MD
Director long term care Cordaan, Amsterdam
Care for the elderly in the
Netherlands
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There is a growing elderly population in the Netherlands (with a maximum peak around 2020)
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Care for the elderly in the
Netherlands
• Historically strictly divided care models: nursing
home care and psychiatry
• Psychiatric symptoms: contra-indication for nursing
home admittance
• Ample capacity for crisis-intervention in psychiatric
setting
• Important role for (ambulant) psychiatry in diagnosis
and case management in dementia
• Difference in finance models
• Long term care in clinical setting only
• Outreaching approach only reserved for psychiatry
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Because of the economic situation the
rules of the game in psychiatry change
drastically
Huge decrease in clinical capacity
Long term care slowly being banned from psychiatry
Psychiatric involvement to patients still living at home is being
reserved for complicated cases
More co-operation between psychiatry and other care-professionals
in outreaching dementia care: DOC teams, expert teams
More important role for general practitioners and nurse practitioners
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Also, the care facilities for the elderly,
especially with dementia, are changing
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Traditional
Developments
- Large scaled
homes/wards
- Focus on medication
- Restraints and
fixation common
- All stages of dementia
hospitalized
- Psychiatric symptoms
rare
-Small scaled, groups 6-8
-Focus on atmosphere and
relational aspects
-Fixation banned,
medication minimalized
-Only advanced stages of
dementia, early stages stay
at home much longer
-Psychiatric symptoms
common
This poses a new challenge for the
elderly care in the Netherlands
• Nursing homes physicians specialise in psychogeriatric and
gerontopsychiatric care
• Nurses are being trained in coping with severe behavioural
symptoms
• Special wards are being formed, focussed on short term stay for
crises intervention and “time out” for regular team
• Caring for patients with dementia in small scaled units decreases
the amount of behavioural symptoms significantly
• Specialisation: “young demented patients”, Korsakoff, Huntington’s,
acquired brain damage, elderly chronic psyciatric patients without
severe psychiatric symptoms (i.e. elderly schizofrenic patients)
• Last but not least: we need to reach out!
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Patients with dementia stay at home
much longer…a necessary, wanted,
but firm challenge
Delaying clinical admittance for patients with dementia, with or without
psychiatric symptoms and elderly psychiatric patients is a strong political
driver…
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Home care (home nursing) needs to anticipate on these cases
Geriatricians, nursing home physicians and psychiatrists need to join
forces: case management, diagnosis and treatment close at home and as
cost effective as possible: DOC teams, expert teams
Day care facilities support living at home longer: different models, from
completely being run by volunteers up to full-professional run settings.
Focus on patient and focus on support system (partner, family)
Much to be learned from the Greek: in an individualised, relatively rich
society caring for one another is not common! Nevertheless…
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Mental healthcare and care for the
elderly: time to join forces!
Mental healthcare provider GGZ Ingeest and Cordaan
work together in several ways:
- Education and training of Cordaan professionals by
Ingeest
- Consultation and advice in complicated cases:
involvement in early stages reduces the need for
clinical intervention in case of crises. Consultation
consists of doctor-doctor advise but also (en maybe
even more effective) nurse-nurse advise!
- And of course, if needed, Ingeest takes over the
treatment and sometimes even the patient. But: only
for a short while…
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Summary
The care for the elderly is changing. Patients with psychiatric symptoms are becoming more and
more common in the nursing homes and care facilities. Patients tend to stay at home longer,
inspite of severe symptoms.
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The know-how of the staff in chronic care facilities needs to be updated: training, education,
consultation by mental healthcare
Outreaching care needs to be updated and forces between different specialties must be joined
Investment in psycho-education for non-professional care givers is needed (Greek model)
The dutch situation provides us with some perfect opportunities to effectuate the above:
* Specialised nursing home physiancians care for the elderly in and out of the nursing homes
* Psychologists are already available in the staff of facilities for the elderly
* As are social workers, musical therapists and occupational therapists
Mental healthcare and elderly care need to join forces more frequently
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