The aim of this study was to identify factors associated with vocally disruptive behavior (VDB) in nursing home patients referred to aged care services for treatment, using a case-control methodology. Characteristics of the VDB, reasons for referral, perceived causal factors, and psychotropic use were noted. Twenty-five subjects and controls were examined with the Screaming Behavior Mapping Instrument, the Cornell Scale for Depression in Dementia, the Dementia Behavior Disturbance Scale, and measures of cognition, functional capacity, social activities, and emotional reactions of nursing staff. VDB was associated with other disturbed behaviors, depression, anxiety, severe dementia, functional impairment, communication difficulties, use of psychotropic medication, social isolation, and emotional distress in the nursing staff. Reasons for referral may relate more to the stress experienced by nursing home staff in managing VDB than to specific attributes of the VDB itself.
Family carers of people with a severe mental illness play a vital, yet often unrecognized and undervalued role in Australian society. Respite care services can assist these family carers in their role; however, little is known about their access to these services. The paper addresses this knowledge gap. An exploratory field study was conducted throughout the eastern suburbs of Sydney, Australia, to identify and examine the factors influencing the use and provision of respite services for older carers of people with a mental illness. Semistructured, in-depth interviews, and structured self-completed questionnaires were conducted with older family carers, mental health care professionals, and respite care service providers. Additionally, relevant documents (local policies, strategic plans and reports on respite care) were reviewed. It was found that current respite services are problematic for older family carers of Australians with a mental illness, signalling the need for concerted efforts by carers, health professionals, and service providers to improve access. Changes to respite provision and utilization are recommended.
Objective: To describe nursing home referrals to a multidisciplinary psychogeriatric outreach aervice. Methods: Retrospective case note audit of all nursing home referrals to a psychogeriatric outreach service in Sydney during 1996. Results: Of 106 referrals (mean age 76.9 years) from 22 nursing homes, 101 (95%) were assessed in the home. Behavioural problems were identified in 87 referrals (82%), usually being associated with chronic organic brain syndromes including dementia (n = 75, 86%). Aggressive behaviours (45%), agitation (32%), uncooperativeness (17%) and vocally disruptive behaviour (16%) were the most frequently identified problems. Depression was diagnosed in 33 referrals (31%), often comorbid with dementia (n =16). Multiple diagnoses were present in 58 (55%) referrals. The most frequent treatment recommendations related to the use of nursing interventions (73%), psychotropic medication (70%), behavioural programs (29%) and family involvement (29%). Admission to the acute psychogeriatric ward occurred in 18 cases (17%). Conclusion: Psychogeriatric services should provide adequately staffed outreach teams to nursing homes.
RESULTSDuring 1996, there were 106 referrals, of whom 67 were female, involving 97 residents (seven were referred twice, one three times) from 22 nursing
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