Oceans Expert: Why we focus on geriatric psychiatry

Jul 25th, 2017

By: Charla Anderson, Regional Director of Clinical Operations, Oceans Healthcare

By 2020, the population of Americans 85 and older is estimated to reach 6.6 million, and in the next 30 years the number of individuals 65 and older is expected to double to 80 million. The United States is rapidly approaching a society with significantly more elderly adults, which will directly impact our healthcare system.

Combined with a growing lack of behavioral health resources and access to care, this could mean many elderly patients with mental illnesses such as depression, bipolar disorder, behavioral complications of Alzheimer’s or dementia, anxiety disorders or late-life psychoses, could fall  victim to the increasing gaps in care.

Expanding access to inpatient psychiatric treatment is necessary to meet the mental health needs of this growing elderly adult population. Older adults have special physical, emotional and social needs. Geriatric behavioral health services are specifically tailored to meet those needs in order to maximize the patient’s quality of life and functionality.

What does a typical geriatric behavioral health patient look like?

An average geriatric behavioral health patient is in their 60s and might require a walker or wheelchair to move around. Their primary diagnosis can range from major depressive disorder, psychosis, depression, anxiety, obsessive compulsive disorder, bipolar, post-traumatic stress disorder or schizophrenia, as well as other serious behavioral health challenges associated with Alzheimer’s and dementia. At a behavioral hospital, it is not the condition alone that will be treated – instead, care staff will treat the behavioral symptoms. For example, patients with dementia can often exhibit aggression or suffer from hallucinations. A behavioral hospital will address the aggression or hallucinations to stabilize the patient, ensuring they are no longer a danger to themselves or others, then release the patient to their family, caregiver or assisted living, long-term or nursing home facility.

Many patients have multiple medical issues or diagnosis known as comorbidities. This means, in addition to the mental health diagnosis, a patient may suffer from one or more medical issues, such as a patient with schizophrenia who also suffers from diabetes. The hospital clinical staff can provide medication management and treat a medical condition as long as the mental health issue is the primary diagnosis.

What sets geriatric psychiatry apart from other forms of psychiatry?

Different equipment and setting
One of the most crucial differentiators between geriatric psychiatry and adult psychiatry is the separation of age groups. Unlike a traditional hospital or emergency room, patients are separated based on age. Behavioral hospitals can include pediatric, adolescent, adult and geriatric units. While a mixed age group setting is not a significant factor in traditional hospitals due to patients being restricted to their rooms, patients are supervised within a locked community setting and therapeutic environment in behavioral health hospitals. This allows patients to feel comfortable and interact in a setting of their peers with similar characteristics and diagnoses.

Additionally, due to the nature of the mental health diagnoses treated at behavioral hospitals, living spaces and equipment must be adapted to reduce any potential for self-harm. Nurses are required to be especially vigilant when performing their rounds in order to monitor for conflict, contraband or safety concerns between individuals or patients who may be a danger to themselves. 

Separate and specific programming
In contrast to adult and adolescent units, the geriatric psychiatry unit places a larger emphasis on programming and interaction in addition to medication management. Depending on their diagnosis, patients can participate in hobby and leisure activities such as arts and crafts, or utilize therapy sessions including sensation therapy or reminiscence therapy.

Reminiscence therapy involves the discussion of a patient’s past activities, events and experiences, usually with the aid of photographs, music, tapes and recordings or other familiar items from the past. In these therapy sessions, patients are encouraged to talk about past events at least once a week. Often in one-on-one sessions, the patient and therapy leader create a life review in which the patient is guided through their life experiences and asked to evaluate them. The ultimate goal of reminiscence therapy is to improve self-esteem, fulfillment and comfort as patients review their lives. Because therapy can be offered informally both one-on-one or in a group setting, conversing about their past experiences allows the patient to interact with others and improve their communication in the present.

Skilled staff
In an average size geriatric unit of twenty-two patients, there is one mental health technician staffed for every five patients. Additionally, one registered nurse, one licensed practical nurse, a board-certified or board-eligible psychiatrist and a medical provider is available around the clock. These staff members have completed age-specific competencies that allow them to specifically understand, interact and treat geriatric patients suffering from mental health conditions and comorbidities. They are trained to address the unique challenges that face behavioral health staff, such as administering medications, assisting with programming, and monitoring patients who are unrestricted and may suffer from suicidal or homicidal ideation.

At discharge, patients are provided with a safe plan for ongoing care or set up with on-going support appointments and instructions in an outpatient setting. Case managers work with patients and/or family members to determine if the patient can return home, or provide assistance identifying an assisted living, long-term or nursing home facility.

Despite the challenging nature of behavioral health, geriatric psychiatry care staff are passionate about helping the elderly population manage the obstacles that come with aging and attain the best possible quality of life. At Oceans, we continue to pursue the mission of expanding access to quality inpatient and outpatient programs focused on the behavioral health needs of older adults.

Charla Anderson is a Certified Psychiatric Registered Nurse and has worked in behavioral health for over 11 years. She oversees clinical services for all Oceans Healthcare’s facilities in Texas.

For more information about Oceans Healthcare’s services or to find a provider near you, please visit OceansHealthcare.com


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