Day hospital for old, mentally disabled needed now

Press, 22 June 1983, Page 9

Day hospital for old, mentally disabled needed now

By

DENIS DWYER,

information officer, North

Canterbury Hospital Board.

Most people will know of an elderly person who is becoming very forgetful of recent events, muddled in thinking, unpredictable in mood and behaviour, unsure about time and place, and who is becoming increasingly restless and inclined to wander. If this elderly person is, living alone, her decreasing’ ability to care for herself becomes evident — clothes go unwashed, baths are neglected, meals are forgotten and cigarettes are left burning; she progressively becomes a danger to herself and possibly to others. The condition is more common in women because they live longer. We are not discussing an elderly person whose confusion is of short duration associated with an acute physical illness or the effect of drugs (which conditions may well be reversible). Nor are we talking of the benign forgetfulness of old age. We are discussing the clinical picture of dementia, in which there is a slow, but progressive impairment of intellect, memory, and personality brought about by an organic disease of the brain. By far the commonest form of dementia with which we have to cope is of the Alzheimer type. Recent studies in New Zealand show that 8 per cent of those over the age of 65 (and 19 per cent of those over the age of 80) have some dementia. Figures in Britain are similar to those found in New Zealand. These figures become even more important when we realise that there will be an increase in the total number of patients reaching the age of 65 by the year 2000 — at least 18 per cent. Most elderly people with mild dementia are cared for in their own homes. Provided they are supported, they do not need hospital care. The condition is a progressive one for which there is no cure. But much can be done through medication and management to help these elderly people gain the maximum satisfaction from life. Their care, however, makes particular stressful

demands on the family, friends and neighbours. It places additional responsibilities on the community and institutional services. As part of the health care of the elderly, the North Canterbury Hospital Board provides a supportive and advisory service whereby patients referred by their own doctor are assessed and advice is given about their management — in their own homes. Some eight years ago a Psychogeriatric Assessment Unit was established at Sunnyside Hospital (Cluny Villa) where patients suffering from Alzheimer’s Disease (as well as other psychiatric illnesses occurring in old age) could be admitted and helped. This unit works in close association and collaboration with the Assessment and Rehabilitation Unit at The Princess Margaret Hospital. There are regular exchange visits by the medical personnel of both units. Dr Maurice Otley, the clinician in charge of the unit, assesses all referred patients in their usual place of residence. Usually it is found necessary to admit about a quarter of these cases to the unit for further assessment and investigation before they return home or go to long stay care. The first object of the service is to determine if there is any reversible condition present. Although patients require skilled management, a very important part of the service is family support, and frequent group meetings are held. The limited facilities in the unit are under considerable pressure. The villa is usually full. Many patients admitted for assessment are found to require long-stay care in the hospital, and so must remain in the unit until a vacancy occurs in the longstay area. Most hospitals in Britain have separate psychiatric day hospitals for the elderly. Many patients treated there do not require hospital admission. Recent figures at Sunnyside Hospital show that one third of

those admitted to the villa could have been managed in this way. “But a day hospital would do even more than this,” says Dr Otley. “It would provide support to the families of demented patients as well as allowing early discharge from the unit. “A day hospital would allow early intervention and free beds in the unit for the care of patients in a crisis.” Mrs Pat Wood, social worker at the unit, believes that the day treatment and specialised day care would provide much relief for the families which is not available at present. In most cases, dementia is best managed in the community with support. Only those with marked restlessness or unacceptable social behaviour need admission. Every effort is made to maintain patients in their own environment. The nursing staff in the ward is actively involved, not only in the routine care of patients but also in their assessment and rehabilitation. The occupational therapist plays a very important role in assessing the extent of their loss of skill in performing even basic functions. There is always a waiting list of patients for admission to the long-stay area, or transfer there after assessment. As the assessment ward is full, it is usually not possible to admit referred patients within a few days. The need to provide for the elderly will become even greater in the future. One of the dilemmas for planner, administrator, and taxpayers alike is how to redeploy our limited existing resources to meet preventive and treatment needs of younger patients, and at the same time expand services for the elderly. “The provision of mental health care for the elderly,” Dr Otley says, “is an area which has not received due attention from policy makers and the public.” “The number of patients needing this service is increasing, and will continue to do so for many years. “If our health service is to provide adequate care in future years, this is an issue which must be grappled with now.”