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A psychiatric intensive care unit for older adults: an interval comparison of admissions

Published online by Cambridge University Press:  26 February 2009

Gary S. Stevenson ,
Muhammad A. Khan  and
Nagarajan Perumal
Gary S. Stevenson*
Affiliation:
Department of Psychiatry (Older Adults), NHS Fife – Stratheden Hospital, Cupar, Fife, Scotland
Muhammad A. Khan
Affiliation:
Department of Psychiatry (Older Adults), NHS Fife – Stratheden Hospital, Cupar, Fife, Scotland
Nagarajan Perumal
Affiliation:
Department of Psychiatry (Older Adults), NHS Fife – Stratheden Hospital, Cupar, Fife, Scotland
*
Correspondence should be addressed to: Dr Gary S Stevenson, Medical Offices, Stratheden Hospital, Cupar, Fife KY15 5RR, U.K. Phone: +44 1334 652611; Fax: +44 1334 696042. Email: gstevenson@nhs.net.
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Abstract

Background: Published information on psychiatric intensive care provision and requirements of older adults is limited. This audit aims to describe and compare demographic data, clinical characteristics and outcomes of patients admitted to a Scottish regional psychiatric intensive care unit (PICU) for older adults during two 18-month periods five years apart.

Method: Data on all patients admitted to the PICU for older adults during the two sample periods, commencing 2001 and 2006 respectively, were collected prospectively by the clinical care team, and included information on previous psychiatric contact and detentions under mental health legislation, diagnoses, cognitive ratings, reasons for transfer to the PICU, treatments and outcomes. Continuous variables were subject to statistical analyses.

Results: Twenty-one and 20 male patients were admitted during the 2001 and 2006 cohorts respectively, with equivalent mean ages of 72.9 years. The majority of patients were married, diagnosed with dementia, with similar levels of previous psychiatric admissions and detentions under mental health legislation. The commonest reason for transfer to the PICU was physical aggression. The 2006 cohort exhibited shorter inpatient stays prior to transfer to, and shorter durations of stay in, the PICU.

Conclusions: The PICU for older adults provides a function similar to the PICU for general adults. The cohorts were similar on most recorded variables, with noted differences possibly reflecting increased awareness and acceptance of the service, reduced tolerance by staff of aggressive behaviors by patients, and enhanced community services in the region. These perceptions warrant further study and clarification.

Keywords

mental healthgeriatricintensive careaggressiondementia
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 2 , April 2009 , pp. 278 - 285
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Almvik, R., Rasmussen, K. and Woods, P. (2006). Challenging behavior in the elderly-monitoring violent incidents. International Journal of Geriatric Psychiatry, 21, 368–374.CrossRefGoogle ScholarPubMed
Beer, M. D., Paton, C. and Pereira, S. (1997). Hot beds of general psychiatry: a national survey of psychiatric intensive care units. Psychiatric Bulletin, 21, 142–144.CrossRefGoogle Scholar
Beer, M. D., Pereira, S. M. and Paton, C. (2001). Psychiatric intensive care – development and definition. In Beer, M. D., Pereira, S. M. and Paton, C. (eds.), Psychiatric Intensive Care (pp. 1–11). London: Greenwich Medical Media.Google Scholar
Bowers, L., Jeffrey, D., Bilgin, H., Jarrett, M., Simpson, A. and Jones, J. (2008). Psychiatric intensive care units: a literature review. International Journal of Social Psychiatry, 54, 56–68.CrossRefGoogle ScholarPubMed
Brown, S. and Bass, N. (2004). The psychiatric intensive care unit (PICU): patient characteristics, treatment and outcome. Journal of Mental Health, 13, 601–609.CrossRefGoogle Scholar
Burns, A. and De Deyn, P. (2006). Risperidone for the treatment of neuropsychiatric features in dementia. Drugs and Aging, 23, 887–896.CrossRefGoogle ScholarPubMed
Crowhurst, N. and Bowers, L. (2002). Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice. Journal of Psychiatric and Mental Health Nursing, 9, 689–695.CrossRefGoogle ScholarPubMed
Day, K., Carreon, D. and Stump, C. (2000). The therapeutic design of environments for people with dementia: a review of the empirical research. Gerontologist, 40, 397–416.CrossRefGoogle ScholarPubMed
Department of Health (2002). Mental Health Policy Implementation Guide for National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments. London: Department of Health.Google Scholar
Dix, R. and Williams, K. (1996). Psychiatric intensive care units, a design for living. Psychiatric Bulletin, 20, 527–529.CrossRefGoogle Scholar
Duxbury, J. and Whittington, R. (2005). Causes and management of patient aggression and violence: staff and patient perspectives. Journal of Advanced Nursing, 50, 469–478.CrossRefGoogle ScholarPubMed
Gill, S. S. et al. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146, 775–786.CrossRefGoogle ScholarPubMed
Howard, R. J. et al. (2007). Donepezil for the treatment of agitation in Alzheimer's disease. New England Journal of Medicine, 357, 1382–1392.CrossRefGoogle ScholarPubMed
Information Services Division (2007). Older People Services: Measuring Relative Need. Statistical Report 2007. Available at: www.isdscotland.org.Google Scholar
Jeffery, A. and Goldney, R. (1982). An innovation: the psychiatric intensive care unit. Australian Nurses Journal, 12 (5), 42–43, 49.Google ScholarPubMed
Kavirajan, H. and Schneider, L. S. (2007). Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomized controlled trials. Lancet Neurology, 6, 782–792.CrossRefGoogle Scholar
McLeod, C., Yorston, G. and Gibb, R. (2008). Referrals of older adults to forensic and psychiatric intensive care services: a retrospective case-note study in Scotland. British Journal of Forensic Practice, 10, 36–43.CrossRefGoogle Scholar
Michalon, M. and Richman, A. (1990). Factors affecting length of stay in a psychiatric intensive care unit. General Hospital Psychiatry, 12, 303–308.CrossRefGoogle Scholar
Mitchell, G. D. (1992). A survey of psychiatric intensive care units in Scotland. Health Bulletin, 50, 228–232.Google ScholarPubMed
NHS Quality Improvement Scotland (2007). Standards for Integrated Care Pathways for Mental Health. Edinburgh: NHS Quality Improvement Scotland. Available at: www.nhshealthquality.org.Google Scholar
NICE (2006). Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer's disease. NICE Technology Appraisal 111. London: National Institute for Health and Clinical Excellence.Google Scholar
NICE and Social Care Institute for Excellence (SCIE) (2006). Dementia: supporting people with dementia and their carers in health and social care. NICE Clinical Guideline 42. London: NICE.Google Scholar
Nijman, H. L. I. (2002). A model of aggression in psychiatric hospitals. Acta Psychiatrica Scandinavica, 106, 142–143.CrossRefGoogle Scholar
Palmstierna, T., Huitfeldt, B. and Wistedt, B. (1991). The relationship of crowding and aggressive behavior on a psychiatric intensive care unit. Hospital and Community Psychiatry, 42, 1237–1240.Google ScholarPubMed
Pereira, S., Dawson, P. and Sarsam, M. (2006a). The national survey of PICU and low secure services: 2. Unit characteristics. Journal of Psychiatric Intensive Care, 2, 13–19.CrossRefGoogle Scholar
Pereira, S., Dawson, P. and Sarsam, M. (2006b). The national survey of PICU and low secure services: 1. Patient characteristics. Journal of Psychiatric Intensive Care, 2, 7–12.CrossRefGoogle Scholar
Rachlin, S. (1973). On the need for a closed ward in an open hospital: the psychiatric intensive-care unit. Hospital and Community Psychiatry, 24, 829–833.Google Scholar
Rippon, T. J. (2000). Aggression and violence in health care professions. Journal of Advanced Nursing, 31, 452–460.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (1998). Not just bricks and mortar. Report of the Royal College of Psychiatrists Working Party on the Size, Staffing, Structure, Siting and Security of New Acute Adult In-patient Units. Council Report CK62. London: Royal College of Psychiatrists.Google Scholar
Schneeweiss, S., Setoguchi, S., Brookhart, A., Dormuth, C. and Wang, P. S. (2007). Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. Canadian Medical Association Journal, 176, 627–632.CrossRefGoogle ScholarPubMed
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network (2006). Management of Patients with Dementia. SIGN Publication No.86. Edinburgh: Scottish Intercollegiate Guidelines Network.Google Scholar
Smith, A. (1997). Survey of locked facilities in Scottish psychiatric hospitals. Psychiatric Bulletin, 21, 77–79.CrossRefGoogle Scholar
Smith, A. D. and Humphreys, M. (1997). Characteristics of in-patients transferred to a locked ward in a Scottish psychiatric hospital. Health Bulletin, 55, 77–82.Google Scholar
Stevenson, G. S., Shankar, P. and Malkison, F. (2005). Utility of a Scottish regional intensive psychiatric care unit for demented elders. International Journal of Geriatric Psychiatry, 20, 389–390.CrossRefGoogle ScholarPubMed
Stevenson, G. S., Menon, A. and Gallacher, N. (2006a). A psychiatric intensive care unit for older adults. Journal of Psychiatric Intensive Care, 2, 103–110.CrossRefGoogle Scholar
Stevenson, G. S., Ewing, H., Herschell, J. and Keith, D. (2006b). An enhanced assessment and support team (EAST) for dementing elders – review of a Scottish regional initiative. Journal of Mental Health, 15, 251–258.CrossRefGoogle Scholar
Walker, Z. and Seifert, R. (1994). Violent incidents in a psychiatric intensive care unit. British Journal of Psychiatry, 164, 826–828CrossRefGoogle Scholar
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioral Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.Google Scholar