Nursing Home Care as an Alternative to Psychiatric Hospitalization

Linn, Margaret W.; Gurel, Lee; Williford, William O.; Overall, John E.; Gurland, Barry J.; Laughlin, Phil; Barchiesi, Alessandro

doi:10.1001/archpsyc.1985.01790290022002

Cited by 63 publications

(16 citation statements)

References 24 publications

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“…On the one hand, cognitive function tends to be more impaired among hospital inpatients relative to nursing home patients (Nagatomo et al 1997;Teitelbaum et al 1991), and more dependent patients are more likely to be concentrated in hospital settings (Campbell et al 1990). On the other hand, activ-ities of daily living appear to be more impaired in nursing home patients (Nagatomo et al 1997), and these patients show more depression and behavioral deterioration than do patients in hospital settings (Linn et al 1985). The more severe agitation and psychopathology seen in the nursing home patients in the present study may therefore reflect the greater debilitation in behavioral state that has been seen in other analyses (Linn et al 1985).…”

Section: Discussionmentioning

confidence: 39%

“…4 ities of daily living appear to be more impaired in nursing home patients (Nagatomo et al 1997), and these patients show more depression and behavioral deterioration than do patients in hospital settings (Linn et al 1985). The more severe agitation and psychopathology seen in the nursing home patients in the present study may therefore reflect the greater debilitation in behavioral state that has been seen in other analyses (Linn et al 1985). Furthermore, the general absence of major treatment differences in the present study may represent the broad efficacy and tolerance of the pharmacological interventions, regardless of setting.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Rapidly Acting Intramuscular Olanzapine, Lorazepam, and Placebo A Double-blind, Randomized Study in Acutely Agitated Patients with Dementia

Meehan

Wang

David

et al. 2002

Neuropsychopharmacology

171

135

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This double-blind study investigated the efficacy and safety of rapid-acting intramuscular olanzapine in treating agitation associated with Alzheimer's disease and/or vascular dementia. At 2 h, olanzapine (5.0 mg, 2.5 mg) and lorazepam (1.0 mg) showed significant improvement over placebo on the PANSS Excited Component (PANSS-EC) and Agitation-Calmness Evaluation Scale (ACES),It has been estimated that 5% of people older than 65, and up to 20% of those aged 80 and older, are affected by dementia (Gurland and Cross 1982;Small and Jarvik 1982). Of these, nearly half exhibit behavioral disturbances, such as agitation, wandering, and violent outbursts (Kunik et al. 1994). Agitation has been defined as "inappropriate verbal, vocal, or motor activity not explainable by apparent needs or confusion" (CohenMansfield 1986), and includes both physically and verbally aggressive behaviors such as hitting, biting, and From the Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana (KMM, HW, SRD, JRN, BJ, CMB, PDF, AB), Institute of Psychiatry, Medical University of South Carolina, Charleston, South Carolina (JEM), and Senior Choice Unit, Presbyterian Hospital, Oklahoma City, Oklahoma (LMB).Address correspondence to: Dr. Alan Breier, Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, Tel.: (317) Fax: (317) 433-5101. Received February 12, 2001; revised May 23, 2001; accepted September 7, 2001.Online publication: 9/13/01 at www.acnp.org/citations/Npp 091301174.N EUROPSYCHOPHARMACOLOGY 2002 -VOL . 26 , NO . 4 Rapidly Acting IM Olanzapine in Dementia 495 screaming, and nonaggressive behaviors such as pacing, wandering, and continual requests for attention. In nursing home patients with dementia, the prevalence of these disturbances may be as high as 75% (Deutsch and Rovner 1991). Severe symptoms of agitation may require rapid treatment in the form of parenteral medication when a very rapid onset is required or when patients refuse or cannot take oral agents. In some instances, the use of medication is less desirable than alternative methods such as behavioral intervention. However, occasions arise where a pharmacological intervention is unavoidable and in the best interests of the patient. Lorazepam is commonly used for treatment of acute agitation, and the benzodiazepines are currently among the few agents available in a parenteral formulation for treatment of agitation. Use of orally administered atypical antipsychotics such as olanzapine and risperidone has met with some success in treating behavioral disturbances in patients with dementia (Clark et al. 2001;De Deyn et al. 1999;Katz et al. 1999;Street et al. 2000). A parenteral formulation of a second-generation antipsychotic might offer some advantage over their corresponding oral formulations due to faster onset of effect and utility where the patient cannot, or will not, accept oral treatment (Bianchetti et al. 1980;Schaffer et al. 1982). Rapid tranquilization with parenteral...

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Section: Discussionmentioning

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Comparison of Rapidly Acting Intramuscular Olanzapine, Lorazepam, and Placebo A Double-blind, Randomized Study in Acutely Agitated Patients with Dementia

Meehan

Wang

David

et al. 2002

Neuropsychopharmacology

171

135

View full text Add to dashboard Cite

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“…One explanation of the positive outcome of the relocation to the nursing home could be that the staff were positive and well educated and had met "their patients" in the hospital before the relocation. Linn et al (1985) studied 403 mentally ill patients relocated to four different types of care over 1 year and found that the elderly chronic schizophrenics changed their ADL functioning for the worse when relocated to a nursing home, but improved when moved to another ward in the mental hospital. They also found that the demented patients did not change their ADL functioning in any of the settings.…”

Section: Discussionmentioning

confidence: 99%

The closure of a mental hospital in Sweden: Characteristics of patients in long-term care facing relocation into the community

Dencker

Gottfries

1991

Eur Arch Psychiatry Clin Nuerosci

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A political decision to decentralize psychiatric care in a county of Sweden was made in October 1984, leading to the closure of the only large mental hospital in the area (290,000 inhabitants). The hospital is of the traditional type, with 490 beds and 1,294 staff members. It has units for long-term care, short-term care and rehabilitation and a unit for research and education. The long-term care is to cease completely and be replaced by community-based alternative types of care. In this study, the long-term population (n = 199) was characterized and their levels of functioning were measured. The results showed that 91% of the patients were 65 years old or more and that more than half of them were organically demented. Only 20% were chronic schizophrenics. All patients were cognitively impaired and 80% were also impaired in ADL functioning. A correlation between length of stay in hospital and ADL functioning was found in the organically demented group, but not in the group of chronic psychiatrically ill patients. Thirty-nine per cent of the population were severely impaired in ADL functioning and needed nursing care around the clock; 34% were moderately impaired and needed help and support that could be given in alternative types of care; 27% were not impaired at all to mildly impaired and could be relocated to some type of service apartment. Thus, all patients needed sheltered living arrangements and care provided by staff with adequate training.

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“…However, this may be a false negative result, since the majority of the discharges took place during 1989and 1990, and clearly only those who were alive at the time were eligible for discharge. The evidence that hospital dis charge of elderly former long-stay patients is associ ated with an increase in death rate is equivocal (Linn et al, 1985). Further large-scale studies on the risks of discharge are required.…”

Section: Discussionmentioning

confidence: 99%

“…It may be that private sector entrepreneurs, identifying an undoubted gap in the market, will move in and develop specialist facilities 'Elderly graduates ' and a hospital closureprogramme for the more dependent elderly functionally mentally ill. Experience of the fate of elderly psychiatric hospi tal residents discharged into nursing homes in the United States has been highly problematic (Brown, 1985;Linn et al, 1985). Although it has been argued that comparisons between the private sectors in the USA and Britain are misleading (Perkins et al, 1989), the current British government strategy which specifically encourages a "mixed economy of care" must be a cause for concern.…”

Section: Discussionmentioning

confidence: 99%

‘Elderly graduates’ and a hospital closure programme: the experience of the Camberwell Resettlement Team

Holloway

1991

Psychiatr. bull.

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The closure of Britain's large psychiatric hospitals, long foreseen, is now rapidly becoming a reality. Surprisingly little is known about the process and outcome of the relocation of long-stay hospital residents. One area of particular concern is the fate of ‘elderly graduate’ patients, who are by convention defined as long-stay patients aged over 65 years who came into continuous psychiatric contact before the age of 65. (More cynically they might be defined as those elderly patients whom our colleagues specialising in the psychiatry of the elderly choose not to take over). This paper documents the experience of a specialist resettlement team working within a declining mental hospital attempting to place ‘elderly graduate’ hospital residents into community provision.

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Nursing Home Care as an Alternative to Psychiatric Hospitalization

Cited by 63 publications

References 24 publications

Comparison of Rapidly Acting Intramuscular Olanzapine, Lorazepam, and Placebo A Double-blind, Randomized Study in Acutely Agitated Patients with Dementia

Comparison of Rapidly Acting Intramuscular Olanzapine, Lorazepam, and Placebo A Double-blind, Randomized Study in Acutely Agitated Patients with Dementia

The closure of a mental hospital in Sweden: Characteristics of patients in long-term care facing relocation into the community

‘Elderly graduates’ and a hospital closure programme: the experience of the Camberwell Resettlement Team

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