The rationale of patient allocation for psychogeriatric assessment

Abstract

SUMMARYOur review of 100 patients using the Camdex and Crichton assessment schedules shows that the severity of illness and degree of dependency are similar in day hospital and inpatient assessment groups. The main predictors of allocation for inpatient assessment and eventual placement in long-stay geriatric wards were restlessness, irritability, the need for assistance with self-care and physical illness. More planning and resources need to be mobilized in the assessment of dementia patients and the treatment of problem behaviours.KEY WORDS-Psychogeriatric assessment, inpatient, day patient.Most psychiatric services offer day hospital and inpatient assessment facilities for the elderly with organic impairment but there is very little written about the rationale for patient allocation. We evaluate the characteristics of day patient and inpatient assessment groups, investigate the variables which appear to influence patient allocation and discuss alternatives to the current assessment procedures. SERVICE CONTEXTThe Department of Psychogeriatrics in Coventry serves a population of 300 000. It has a 20-bedded inpatient assessment unit with facilities for night relief and respite care admissions, a day hospital with 25 places for assessment and treatment, a 28-bedded inpatient unit for functional mental illness in the elderly, three medium dependency wards with 51 beds, one high dependency unit with 25 beds, onsite outpatient facilities and an active multidisciplinary community support team for the elderly.Coventry has a wide range of community facilities for the elderly, with social services, voluntary and private provisions which include day centres, luncheon club, semi-sheltered accommodation, sheltered accommodation, rest homes, part I11 homes and private nursing homes.Correspondence to Dr S. Handy. METHODFifty consecutive psychogeriatric day hospital assessment patients and 50 consecutive inpatients for assessment were evaluated using the Camdex interview schedule (Roth et al., 1986) conducted after one week of assessment and Crichton schedule (Robinson, 1961) evaluated over a one-month period. The information was collected to compare type and severity of dementia, relative support, physical health, accommodation prior to admission, overall dependency, the degree of assistance needed for self-care, continence, sleep, mobility and temperament between the two groups. The diagnosis and categorization of the severity of dementia were made according to the Camdex criteria. RESULTSSixty per cent of the day hospital patients were male. The average age was 75.96 years compared to an average age of 75.82 years among the inpatient assessment group, of whom 46% were male. Seventy per cent of the day hospital patients had a diagnosis of senile dementia of Alzheimer's type (SDAT), 12% had a diagnosis of vascular dementia (VD), 16% had both SDAT and VD, and only 2% received other diagnoses. Similarly, 66% of the inpatients group had a diagnosis of SDAT, 24% had VD, 6% both SDAT and VD, and 4% received

Idiopathic clouding of consciousness—do the patients have cortical lewy body disease?

“…A 4-week assessment is conducted on each patient. There is no strictly defined procedure detailing whether the patients are referred to the day hospital or for inpatient assessment; the characteristics of the patients in the two different settings are described in detail elsewhere (Handy et al, 1991). Both groups had a predominance of patients with dementia of mild to moderate severity, although those allocated to day hospital assessment had fewer behavioural problems and were more likely to have family carers.…”

Physical assaults by psychogeriatric patients: Patient characteristics and implications for placement

“…A further 20% engaged in fear-provoking behaviour. Irritability 0885-6230/93/0605 1 5-06$08.00 @ 1993 by John Wiley & Sons, Ltd and aggression also influence future placement, particularly increasing the likelihood of long-stay hospital care (Handy et at., 1991;Lam et al, 1989;Shah, 1992).…”