Psychiatric program fills gap in treatment of elderly, mentally ill patients

February 16, 1993|By Sherry Joe | Sherry Joe,Staff Writer

Instead of seeking treatment in nursing homes, hospitals and state mental institutions, increasing numbers of Howard County's mentally ill seniors are turning to Taylor Manor Hospital's 2-year-old Geropsychiatric Program.

Since opening as Howard County's only psychiatric program for elderly patients, the 20-bed Geropsychiatric Program has treated about 500 people for depression, anxiety, psychosis and memory difficulties.

The program's reputation has spread, and hospital officials hope to expand the unit to 40 beds within five years.

"People are getting to know our reputation," said Dr. William Mansbach, associate director of Geropsychiatry. "We've gotten calls from West Virginia and Southern Maryland."

Before the Geropsychiatric Program opened, many mentally ill senior citizens received poor treatment or none at all.

"The biggest problem was finding placement for patients who came into the emergency room with psychiatric disorders," said Lynn Winemiller, unit coordinator of the Geropsychiatric Program.

Ill-equipped to treat mentally ill geriatric patients, some nursing homes would evict patients or give them large doses of medicine to quell emotional outbursts, Ms. Winemiller said.

"They get shuffled from one place to another," Ms. Winemiller said. "They get kicked out of a nursing home, and then they get sent to an emergency room, where they're placed in another nursing home."

Roughly half of the patients in the Geropsychiatric Program are from nursing homes. Some patients admit themselves, and others are referred by physicians, family members, a psychiatrist, a social worker, a psychologist or another professional therapist.

Patients stay for an average of 30 to 60 days.

Tucked away in the hills above Ellicott City, the private psychiatric hospital has a separate ward for its geriatric patients. There are three patients for each nurse, compared to the typical 5-to-1 or 7-to-1 ratio, hospital officials said.

Mentally ill geriatric patients need special attention, officials say, because physical ailments must be distinguished from psychiatric ones.

Depression can by caused by the loss of a spouse, retirement, residential relocation or a physical ailment such as a heart attack, stroke or even a bladder infection.

"A person in their 70s who has been in good health for most of their life becomes aware that they're finite," said Dr. Virginia L. Billian, director of geropsychiatry.

That realization can cause depression. To distinguish between physical problems and mental illness, patients first undergo a complete exam by a psychiatrist, psychologist, internist, nurse, social worker and neuropsychologist.

"We do a lot of ruling out medical problems," Ms. Winemiller said.

If no physical problem is found, patients are assessed to determine what kind of mental illness they have and what treatment is needed.

One in three people in nursing homes is depressed, but few receive treatment because they are reluctant to talk about their mental well-being or are embarrassed to seek psychiatric treatment.

"I think a lot of people need help or know others who do but are not getting help," Ms. Winemiller said.

Dr. Billian said the patients in the Geropsychiatric Program make up two groups. "The first group are chronically mentally ill and are used to seeking treatment. The other group are those who haven't had psychiatric help," she said.

Inside the Geropsychiatric unit, twin beds occupy rooms off a main hallway that leads to a day room filled with a couch, easy chairs and a piano. On a recent afternoon, patients read, chatted and watched television. A schedule of therapy groups was posted on a wall.

On Monday, patients discuss personal goals. "For one person, it might be as simple as getting out of bed," Ms. Winemiller said. "For another, it might be something more elaborate: to talk to my family about the way they treat me."

Current events is the topic of discussion on Tuesday.

"It's good to talk about what's going on," Ms. Winemiller said. "When they get this age, they don't have a clue about what's going on."

Patients learn how to lead healthier lives on Thursdays. "We teach them about their medication, special diets, proper hydration, taking care of their feet, diabetes, smoking," Ms. Winemiller said.

Family members are essential to the senior citizen's mental well-being, hospital officials said.

"We really try to work with family members here," Dr. Mansbach said. "If the older person is having problems, then the family is having problems."

Sometimes, a phone call is all that is needed to involve the family in treatment. Other times it takes several hours of talk.

"You do a lot of educating of the family," Ms. Winemiller said.

Dr. Elias Shaya, a Towson psychiatrist, said the program fulfills an important role in geriatric medicine.

"You've got a patient with psych needs with underlying medical needs," said Dr. Shaya, who regularly refers patients to the Geropsychiatric Program. "You cannot only provide psych care; otherwise, you'd be providing sub-optimal care."

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