Title : The Geriatric Psychiatry Inpatient: An Anatomy of Care
Treatment of the geriatric patient on an inpatient unit is among the most complex challenges in clinical psychiatry. The patient is at the nexus of a number of problems, all interacting in ways that are often impossible to parse: aging, neurocognitive decline, non-cognitive symptoms of dementia, acute and chronic medical symptoms, medication interactions, family dynamics, psychosocial losses, and psychiatric/behavioral symptoms. All factors interact to contribute to hospitalization, with the expectation of some clarification and/or resolution. This, in the context of hospitalization days limited by utilization review/insurance coverage, as well as conditions which have no certainty of definitive cure or even amelioration, is of the utmost challenge.
We have developed several algorithms, or Flow-Charts to describe the Decision-analysis of several of the most difficult and complicated inpatient psychiatric problems. The search for diagnoses, which is necessary and helpful, often does not permit the exploration of the interactions or borders of these problems. Hopefully, presentation of the decision-analysis, facilitates an understanding of the interfaces between these several problems.
We believe that the Flow-charts can also be used to illustrate to patients the process of assessment and decision-making, in a clear, understandable fashion.