Evaluation and Treatment of Demented Elderly

There are curre nt ly 27 mill ion people over 65 in the United States and this number will double in th e next 50 years . This will confro n t psychiatrists and ot her physician s with th e ca re of m any elderly pat ients with dementia. T hese pa tien ts will ofte n require hospi tali za tion whe n ill becau se the ir mental, physica l, a nd social func t ioning tends to break down a t once, overwhe lming fami lies and outpatient ph ysician s. Once hospitali zed, th ey require acc ura te di agnoses, multidisciplinary ca re, and planning for rehabi litation from th e on set of th e hospi tali zat ion . However, dementia is ofte n undiagn osed a nd untreated in universi ty hospi tal s as well as in prima ry ca re clinics a nd nursin g homes. The conse q ue nces of th is are limi ted pr osp ect s for clinica l improvement a nd th e likelihood of fur ther decline. Dr. Ros enberg's con t r ibu t ion to th e Jdftrson J ournal ofPsychiatry, " Psychi atric Cons ulta t ion for th e Demented Eld erly" eloq ue n t ly describ es t he d ilemmas of ca ring for elde rly dement ed patients in ge ne ral hospital se tt ings. It is notable th at the psychi atric consultants' initial advice to prescri be a high -poten cy neu rol eptic along with an antich olin ergic agen t is pot entially problematic becau se of demented pa ti ents propen sit y to develop ext rapyramidal side effec ts a nd deli riu m from th ese agents , respectively. Usin g a benzodiazipine is equally pr obl ematic because it may incr ease cog nitive impai rment a nd th e risk of fall s. These com plica t ions con t r ibu te to th e se nse th at gene ra l hospi tal wards are inappropriate places to ca re for demented patients. In stead , such patient s may fare bett er on dedicated ge ria t r ic psychi at ry/medi cal units wh ere the mi lieu and approach es to ca re are design ed to suppo r t impaired pat ients, com pe nsa te for th eir deficit s, a nd st im ula te th eir remaining ca pa bilit ies to ac h ieve th eir high est level of fun ct ion. Care on th e unit sho uld be ca r r ied ou t by a multidisciplina ry tea m under th e direct ion of a ge ria tric psychi atrist. The team sho uld cons ist of geriat ricians, and ge ro n to logica lly-t ra ine d nurses, social workers, a nd occupa tio na l a nd recr eational th erapists. Dr. Rosenberg's case report illu strates th e variet y of dan gers of a n inappropriate placement. Ph ysicians a re angry, nurses a re frus t ra ted , the ward is