Geriatric Psychiatric Patients Research Paper
Geriatric Psychiatry is one of specialties of psychiatry that is based on providing the assessment, diagnosis and treatment of a wide range of complex mental disorders that occur in late stages of life. Actually, Geriatric Psychiatry is aimed at providing professional care for patients and their caregivers at the end stages of the lifecycle, a period of human development when many complicated physical health problems and mental health problems are combined (Miller & Solai, 2013). As a matter of fact, Geriatric Psychiatric Clients require special attention because of their needs. Due to the generation of the new knowledge through scientific research, it is possible to address the needs of Geriatric Psychiatric Clients. Geriatric Psychiatry is developed to provide well-organized care delivery to psychiatric clients, namely the elderly people (Miller & Solai, 2013). The proper psychiatric services are delivered by multidisciplinary teams of health care professionals. The health care locations selected for Geriatric Psychiatric Clients best serve their needs and requirements. In order to have a better understanding of the needs of Geriatric Psychiatric Clients, it is necessary to conduct a comprehensive review of academic literature. Geriatric Psychiatric Patients Research Paper As Geriatric Psychiatry involves advocacy and development of the proper health policies related to the life of the elderly population, it is necessary to have a good understanding of mental illness and mental health problems faced by the elderly people (Reuben et al., 1999; Miller & Solai, 2013; Alexopoulos et al., 2000). In addition, it is necessary to consider the role of Geriatric Psychiatric Clients caregivers and care provider support, as well as the systems of care that refer to Geriatric Psychiatry.
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The scientific literature reviewed reveals many studies aimed at analysis of the needs of Geriatric Psychiatric Clients, as well as other relevant issues. Literature reviewing includes not only recent studies on the issues of Geriatric Psychiatry, but also theoretical framework regarding the various mental health disorders faced by of Geriatric Psychiatric Clients (Alexopoulos et al., 2000; Harvey et al., 2014; Small et al., 1997; Staal et al., 2007; Reuben et al., 1999; White et al., 1997). Actually, recent studies have added some new knowledge to the field of Geriatric Psychiatry.Geriatric Psychiatric Patients Research Paper
In the research study conducted by Philip D. Harvey, Ph.D. and his colleagues (2014), there is much evidence that many Geriatric Psychiatric Clients may suffer from Schizophrenia. Statistical data showed that many geriatric clients diagnosed with schizophrenia have been placed to nursing home care settings. Researchers found that across nursing home settings and chronic hospital settings, there are many poor outcome geriatric patients with schizophrenia. Thus, researchers conducted a research to compare the cognitive, symptomatic, and adaptive functioning of geriatric clients to that of acutely admitted clients with a better outcome over the illness. In this study, there were 3 groups of participants, including 97 chronically hospitalized clients diagnosed with schizophrenia, 37 clients with chronic schizophrenia placed in nursing homes and 31 acutely admitted geriatric clients with the same diagnosis. Actually, researchers used the Positive and Negative Syndrome Scale, in order to rate these patients. In addition, they used “testing with a neuropsychological battery, evaluated with the Mini-Mental State examination, and rated on a scale of social and adaptive deficits, the Social Adaptive Functioning Evaluation scale” (Harvey et al., 2014, p. 1080). The results of the research study showed that for all three groups of participants, cognitive impairment was the major predictor of adaptive deficits in Geriatric Psychiatric Clients, while negative symptom differences among the participants of the three groups were less significant than the differences among Geriatric Psychiatric Clients in cognitive impairment. Besides, researchers found that “nursing home patients had the least severe positive symptoms and the acutely ill and chronic hospital patients did not differ on positive symptoms” (Harvey et al., 2014, p. 1080). The research data showed that the interventions specially developed for Geriatric Psychiatric Clients with cognitive impairment have a strong impact on the overall functional status of the clients.Geriatric Psychiatric Patients Research Paper
In another research study, conducted by Gary W. Small and colleagues (1997), special attention was paid to the diagnosis and treatment of Alzheimer disease (AD) and related disorders in Geriatric Psychiatric Clients. At the consensus conference, organized by the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society in January 1997, primary care physicians discussed a number of questions to address the needs of Geriatric Psychiatric Clients diagnosed with Alzheimer disease. The participants were the experts in psychiatry, neurology, geriatrics, primary care, psychology, nursing, social work, occupational therapy, epidemiology, and public health and policy (Small, 1997). The evidence was taken from the world academic literature on the questions regarding Geriatric Psychiatric Clients diagnosed with Alzheimer disease. Researchers found that Alzheimer disease is one of the most common and at the same time serious health disorders causing cognitive decline in the elderly population. Undoubtedly, this disorder exacts a considerable cost on the life and development of society. It was found that “the diagnosis of AD is often missed or delayed” (Small, 1997, p. 1363). In most cases, elderly patients with AD should be diagnosed and treated in primary care settings, but some Geriatric Psychiatric Clients with atypical presentations, severe impairment, or complex comorbidity can benefit from the referral to specialists. As a matter of fact, Alzheimer disease can be characterized as progressive and irreversible for many Geriatric Psychiatric Clients, but it is possible to use pharmacologic therapies for cognitive impairment and non-pharmacologic and pharmacologic treatments for addressing the behavioral problems associated with dementia in the elderly patients. These therapies can help to improve the quality of life of Geriatric Psychiatric Clients. Besides, researchers found that “psychotherapeutic intervention with family members is often indicated, as nearly half of all caregivers become depressed” (Small, 1997, p. 1363).Geriatric Psychiatric Patients Research Paper This fact means that special attention should be paid to the quality of health care delivery to Geriatric Psychiatric Clients patients because considerable changes in disease management practices can lead to stresses to the entire system. There is much evidence that “new approaches are needed to ensure patients’ access to essential resources, and future research should aim to improve diagnostic and therapeutic effectiveness” (Small, 1997, p. 1363).Geriatric Psychiatric Patients Research Paper
In one of the recent studies on the health problems faced by Geriatric Psychiatric Clients, conducted by Jason A. Staal and colleagues (2007), due attention was paid to the role and effects of standard psychiatric inpatient care provided to elderly patients. Reserchers were focused on a randomized study aimed at assessing 24 participants with moderate to severe dementia. The study was conducted on one of the geriatric psychiatric units which provide care delivery to Geriatric Psychiatric Clients. Actually the participants of the study were provided with the following therapeutic approaches: pharmacological therapy, occupational therapy, and structured hospital environment. In addition, they were randomized in order to be provided with multi-sensory behavior therapy (MSBT) practices and structured activity sessions. Researchers found that the group of participants treated with MSBT and being on standard psychiatric inpatient care demonstrated greater independence in their daily activities than patients who were on standard psychiatric inpatient care without MSBT. The key finding was that the implementation of the combination treatment of MSBT and standard psychiatric care could be effective in reduction of agitation and apathy. In general research findings suggest that “utilizing MSBT with standard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than standard care alone” (Staal et al., 2007, p. 357).Geriatric Psychiatric Patients Research Paper
In another research study, performed by George S. Alexopoulos and colleagues (2000), special attention was paid to the investigation of the “relationship of executive and memory impairment to relapse, recurrence, and course of residual depressive symptoms and signs after remission of geriatric major depression” (p. 285). In this study, there were 58 elderly participants diagnosed with depression who were involved in nortriptyline treatment for 16 weeks and then, they were randomly assigned to two types of treatment practices: nortriptyline maintenance therapy and taking placebo for 2 years. Researchers used Research Diagnostic Criteria and the DSM-IV criteria to make a diagnosis. They assessed executive dysfunction and memory of the participants, applying the Dementia Rating Scale. In addition they assessed disability and social support, using the Philadelphia Multiphasic Instrument. Moreover, researchers assessed medical burden, using the Cumulative Illness Rating Scale. The results of the study showed that “abnormal initiation and perseveration scores, but not memory impairment, were associated with relapse and recurrence of geriatric depression and with fluctuations of depressive symptoms in the whole group and in subjects who never met criteria for relapse or recurrence during the follow-up period” (Alexopoulos et al., 2000, p. 285). Besides, researchers found that the following factors did not have a significant impact on the outcome of depression, namely memory impairment, disability, medical burden, social support, and history of previous episodes. Thus, researchers found that executive dysfunction could be connected with relapse and recurrence of the signs and symptoms of geriatric major depression, as well as with residual depressive symptoms. These findings placed emphasis on the needs for the investigation of the role and effects of specific prefrontal pathways aimed at addressing depressive symptoms in Geriatric Psychiatric Clients.Geriatric Psychiatric Patients Research Paper
In addition, researchers explored the clinical characteristics of elderly psychiatric patients connected with their retention in a hospital setting during a period of rapid reduction in the inpatient census. During the first year of the study, researchers placed emphasis on individual evaluation of elderly impatiens (aged 65 or greater). During the second year of the study, elderly patients remained in the hospital setting in order to be reevaluated. Reserchers conducted the study at Pilgrim Psychiatric Center that is considered to be the largest state hospital in the state of New York. The participants involved in the research study were diagnosed with schizophrenia. The majority of the participants were hospitalized for long periods. They had significant cognitive impairment. In their study, researchers used the Clinical Dementia Rating Scale in order to assess cognitive functioning of their patients. I addition, they used the PANSS to assess the severity of existing psychiatric symptoms. The major results of the study showed that “patients retained had more severe symptoms of excitement, hostility and impulsive behavior than those discharged, while uncooperativeness, delusions, grandiosity and suspiciousness were also more severe in those retained than those discharged” (White et al., 1997, p. 474). Thus, researchers asserted that elderly patients or Geriatric Psychiatric Clients demonstrated behavior disorders, which are rather difficult to manage by caregivers.Geriatric Psychiatric Patients Research Paper
In David B. Reuben and colleagues’ research study (1999), due attention is focused on the problem of comprehensive geriatric assessment, the need for consultation to ensure prevention of the negative effects of the symptoms mental health disorders and adherence to the established standards in treatment and care delivery interventions. Researchers claimed that comprehensive geriatric assessment (CGA) can be used to foster health benefits in health care settings. The major goal of the researchers is to “assess the effectiveness of outpatient comprehensive geriatric assessment consultation coupled with an adherence intervention on 15-month health outcomes” (Reuben et al., 1999, p. 269). In their study, researchers used a randomized controlled trial in community based health care settings. The participants of the study were 363 community-dwelling elderly patients who had not performed a screening for one of the following conditions: “falls, urinary incontinence, depressive symptoms, or functional impairment” (Reuben et al., 1999, p. 269). Researchers conducted a single outpatient CGA consultation and combined it with a well-developed intervention aimed at improving adherence of both physicians and patients with the established CGA recommendations. The results of the study showed that a single outpatient comprehensive geriatric assessment combined with the adherence intervention can help to “prevent functional and health-related quality-of-life decline among community-dwelling older persons who have specific geriatric conditions” (Reuben et al., 1999, p. 269).Geriatric Psychiatric Patients Research Paper
Due to the emergence of a large body of scientific knowledge found in scientific literature, it is possible to make conclusions regarding the etiology and expression of health disorders in Geriatric Psychiatric Clients, as well as to find response to the selection of the appropriate treatment methods for mental health disorders in these patients. Summarizing the data taken form the academic literature on the questions regarding Geriatric Psychiatric Clients, it is possible to generate one’s own personal opinion regarding caring for Geriatric Psychiatric Clients. In this section of the paper, I will discuss what I would do to address the issues associated with Geriatric Psychiatric Clients. I have found that elderly people are especially sensitive to selection of treatment methods and drugs. As a rule, Geriatric Psychiatric Clients have some degree of “brain failure” that affects their life, behavior, attitudes, etc.
There are several health disorders that influence the life of Geriatric Psychiatric Clients. For example, Geriatric Psychiatric Clients may have the symptoms of Behavioral and Psychological Symptoms of Dementia (BPSD), including the symptoms of disturbed perception, verbal and physical aggression, anxiety, paranoia, and depression. Besides, they may have severe depression, Schizophrenia, Alzheimer Disease, and other mental health disorders.Geriatric Psychiatric Patients Research Paper
As a Geriatric Psychiatrist, I will place emphasis on the assessment of some unique situations that require the use of effective strategies taken from general psychiatry, geriatric medicine and neurology science. For example, I will use complex capacity/competency assessments in elderly patients with psychiatric problems in order to make decisions regarding medical treatment, drugs, the opportunity to ensure personal care, etc. In addition, I will assess the appropriateness of polypharmacy, or assess the multiple prescriptions for medical conditions, as well as the possible side effects and the effects of the so called drug-drug interactions.Geriatric Psychiatric Patients Research Paper
Generally speaking, providing care to Geriatric Psychiatric Clients, it is necessary to consider their needs. As a rule, Geriatric Psychiatric Patients may present considerable challenges to health care specialists because of the need for individual approach to each client. It is necessary to use a standard assessment plan, which consists of a list of counseling issues and a brief screening list. It is necessary to remember that a health care specialist who works with Geriatric Psychiatric Patients should use effective strategies to prevent the major causes of morbidity and mortality in the elderly population. As a matter of fact, the assessment allows performing comprehensive health screening and using the proper interventions aimed at improving the quality of life of Geriatric Psychiatric Patients (Miller et al., 2000; Reuben et al., 1999).Geriatric Psychiatric Patients Research Paper
Hence, it is necessary to take into consideration the fact that “the number of persons 65 years of age and older continues to increase dramatically in the United States” (Miller et al., 2000, p. 1089). Due to comprehensive health maintenance screening of the elderly population, namely the screening of sensory perception and injury prevention, it is possible to address the needs of patients with psychiatric disorders. As a health care professional, I will consider the key characteristics of geriatric patients. They have different symptoms of mental health disorders that lead to cognitive impairment, postural hypotension, balance or gait impairment, polypharmacy and use of sedative-hypnotic drugs. I will place emphasis on the following areas of intervention, including immunizations, diets and physical exercises, and sexuality. It is necessary to assess cognitive ability of Geriatric Psychiatric Patients, as well as mental health issues in the context of the social situation of each client. In other words, I believe that it is necessary to use a well-organized approach to address the various aspects of geriatric health.Geriatric Psychiatric Patients Research Paper
Thus, it is necessary to conclude Geriatric Psychiatric Patients require individual approaches to care delivery. Literature review provides much important information about the needs of Geriatric Psychiatric Patients, their health problems and the use of the proper interventions to solve these problems and help elderly patients to improve the quality of life. It is very important to assess the role of Geriatric Psychiatric Clients caregivers and health care providers’ support to ensure that comprehensive health maintenance screening of the elderly population can help to address the needs of patients with psychiatric disorders, such as Dementia, severe depression, Schizophrenia, and Alzheimer Disease. Generally speaking, the interventions specially developed for Geriatric Psychiatric Clients can help to improve their cognitive impairment and the overall functional status, address behavioral problems, depressive symptoms and improve the quality of life.Geriatric Psychiatric Patients Research Paper
Patient falls in hospitals are potentially severe and frequent events that may lead to death or an extensive participation restriction. In the psychiatric unit, patients who fall in the hospital often have more prolonged as well as costly admissions. More importantly, patient falls have been identified as the primary cause of death among people aged 65 and above following the fact that fractures mark as the central category of grave injuries instigated by falls in the psychiatric unit (Khurshid & Lantz, 2016). The severe fall risk hazard among inpatients in the psychiatric unit is a prevalent issue without any definitive solutions. Even with the 15-minute safety checks by medical practitioners in the psychiatric inpatient unit, patient falls remain dramatically high. In this light, this scope sets out to develop a research question correlated to falls in the inpatient psychiatric unit and the most appropriate measures of mitigating these events. Geriatric Psychiatric Patients Research Paper
In general, the rate of falls in a clinical setting is believed to ranges from 3.1 to 3.7 for every 1000 occupied bed days. More significantly, psychiatric parameters have been reported to have a general rate of 4.1-6.4 for every 1000 occupied bed days where inpatient psychiatric units have the high standards ranging 9 to 17.1 for every 1000 occupied bed days. According to Said et al.,(2016), there are various reasons behind falls in the inpatient psychiatric unit with the most dominantly reported individual related factors revolving around confusion or distorted mental state, special toileting needs, gait difficulties and medication effects. External aspects related to falls include bed height, ill-fitting footwear, and wet floors. Also, patient behavior such as impulsive conduct is also associated with falls (Abraham et al., 2016). However, even with the prevalence of this issue in the psychiatric unit, there is a limited body of research that reports the rates and factors related to falls in inpatient psychiatric units in the United States as well as the absolute measures of mitigating them. Nonetheless, the available research in this area reveals that inpatient psychiatric units are at ‘state of neglect’ which further puts the safety mental patient in jeopardy. Rongen et al., (2016), reveal that the number of falls among patients in the psychiatric units is at 13-25 per 1000 days compared to 4 per 1000 bed days for medical-surgical units.Geriatric Psychiatric Patients Research Paper
Abraham et al., (2016) contends that universal fall precautions ought to be considered from the perspective of the patient in the psychiatric unit as well as the physical environment. Echoing on Abraham’s assertions, a study by Triplett et al., (2017), emphasized on precautions constituted on checking on patients including ensuring that the personal possessions of patients are close. For this reason, hourly rounding marks as a remarkable basic strategy. This strategy revolves around typically defined hourly visits from 6 a.m. to 10 p.m. as well as after every 2 hours from 10 p.m. to 6 a.m. This approach is extensively necessary as patient falls in the psychiatric unit are one of the costly as well as sensitive when it comes to quality indicators. Abraham et al., (2016) affirmed that hourly rounding strategies could go an extra mile towards reducing harm incurred through patients’ falls. Geriatric Psychiatric Patients Research Paper
Implication for the Problem of Practice
Following the significance of hourly rounding approaches in the prevention and mitigation of patients falls in the inpatient psychiatric unit, determining the most appropriate hourly rounding strategy is extensively vital. In essence, having a comprehensive understanding of the most efficient hourly approach for mental patient falls would guide medical practitioners, registered nurses (RNs), Certified Nurse Assistants (CNA), Patient Care Technician (PCT) and Nurse’s aide to alternate in providing quality care. Moreover, it would go an extra mile toward reducing costs associated with patients falls, mortality, morbidity as well as the length of hospitalization related to patient falls in the psychiatric unit (Khurshid & Lantz, 2016).
List of Potential Research Questions
In the inpatient psychiatric unit, what is the efficiency of purposeful hourly rounding on the incidence of patient falls compared to hourly structure rounding during the period of bed stay?Geriatric Psychiatric Patients Research Paper
In the inpatient psychiatric unit, what are the outcomes related to routine nursing rounds in preventing patient falls compared to structure hourly rounding during the patient length of hospitalization?
Among psychiatric patients, is the use of compliant flooring efficient in reducing patient falls compared to the use of structured hourly rounding during the length of hospitalization?
In the inpatient psychiatric unit, what is the efficiency of using restraints in preventing patient falls compared to structure hourly rounding during the period bed of stay?
In the inpatient psychiatric unit, what is the efficacy of structure hourly rounding compared to routine nursing rounds during the period of hospitalization? Geriatric Psychiatric Patients Research Paper
Feasibility and Interest
The research questions highlighted above were analyzed for viability according to the availability of resourced in successfully carrying out the study, the presence of a research gap and readiness of evidence-based data to inform the field of research. The first two questions met all the analysis criteria but were eliminated based on the fact that been explored by various preliminary studies have explored them. Although the third issue raised interesting inquiries, it was dismissed for lack of research gap as well as definitive strategies to inform the research. Question four was eliminated for the lack of recent evidenced-based data, while the fifth question was selected following the limited body of research on these strategies identified and it further satisfied all the qualification.
In inpatient psychiatric units (P), is the use of structure hourly rounding (I) compared routine nursing rounds (C) more effective in reducing patient falls (O) during hospitalization (T)?
Population: The research will focus on patients admitted to inpatient psychiatric units. According to Rongen et al., (2016), the number of falls among patients in psychiatric units is at 13-25 per 1000 days compared to 4 per 1000 bed days for medical, surgical units. Moreover, preliminary studies have focused more on geriatric patient falls in medical-surgical units further neglecting inpatient psychiatric units.Geriatric Psychiatric Patients Research Paper
Intervention: The intervention focus is structured hourly nursing rounding which is a systematic and proactive nursing approach that is meant to anticipate as well as cater the needs of patients in inpatient units. According to Mitchell et al., (2014), structured hourly rounding is an excellent strategy that is cost effective and is flexible enough for different clinical settings when it comes to reducing patient’s falls.
Comparator: The efficiency of the recommended intervention will be compared to the use of routine nurse rounds which is mostly used in medical-surgical units. According to Flowers et al., (2016) Routine nurse rounds mark as the key to patient’s perception of care that they receive and is a dominant metric of enhancing the quality of care. However, it is not as comprehensive as structured hourly nursing and lacks the proper mechanisms for targeting psychiatric inpatients.
Outcome: The projected results revolve around the prevention of patient falls in psychiatric units. In essence, patient falls in the psychiatric unit are often associated with injuries, mortality, morbidity as well as the length of hospitalization (Mitchell et al., 2014). Moreover, they also lead to additional massive financial burdens to health care systems related to treating them.
Time: The research will focus on the period of hospitalization following the fact that patient falls in the inpatient psychiatric units are associated with the length of stay, wet floors and bed heights which may cause mortality and long-term morbidity in patients. Geriatric Psychiatric Patients Research Paper
Key Words: Inpatient psychiatric unit, Patient falls, Psychiatric patients, structure hourly rounding, routine nurse rounds, fall injuries, Patient satisfaction, falls prevention, falls precautions. Geriatric Psychiatric Patients Research Paper
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