Intensive Session: New Approaches to Medical Issues in Long-Term Care

Vulnerable long-term psychiatric inpatients need screening for physicalhealth problems: An audit of regular hospital statistics and clinical files

“…Messinger-Rapport et al identify the following as prominent medical issues in long-term care and provide guidelines for their treatment: heart failure, vitamin D, falls, diabetes mellitus, blood pressure, anaemia, clinical nutrition, pressure ulcers, clostridium difficile infection, and insomnia. 6 More specifically, Fisher et al found the following prevalence of physical health problems in 330 long-stay psychiatric inpatients: any medical condition 84%; obesity 31%; serious respiratory problems 24%; dental problems 23%; hypertension 17%; gastro-intestinal disorder 17%; cardiovascular problems 17%; diabetes mellitus 14%; thyroid disease 12%; swallowing disorder 12%; epilepsy 12%; and tardive dyskinesia 12%. 7 A substantial number of patients suffered from more than one medical condition.…”

“…Patients with dementia and delirium or confusion are at a particularly high risk of falling, with institutionalised patients having a 75% yearly prevalence of falls. 6,[19][20][21][22][23] Gait apraxia and unsteadiness often play a role in these falls. 6,19,[23][24][25][26][27] Moreover, these patients' increased risk of falling has much to do with side-effects of psychotropic medicationsespecially antipsychotic medications, but also antidepressants, mood stabilisers, and sedatives -or with ECT.…”

“…6,[19][20][21][22][23] Gait apraxia and unsteadiness often play a role in these falls. 6,19,[23][24][25][26][27] Moreover, these patients' increased risk of falling has much to do with side-effects of psychotropic medicationsespecially antipsychotic medications, but also antidepressants, mood stabilisers, and sedatives -or with ECT. 4,6,20,[23][24][25] Additional factors that increase the risk of falling include female gender, atherosclerotic disease, obesity, lower limb abnormalities, hearing or vision deficits, elevated temperature, anaemia, vitamin D deficiency and postprandial hypotension.…”

“…6,19,[23][24][25][26][27] Moreover, these patients' increased risk of falling has much to do with side-effects of psychotropic medicationsespecially antipsychotic medications, but also antidepressants, mood stabilisers, and sedatives -or with ECT. 4,6,20,[23][24][25] Additional factors that increase the risk of falling include female gender, atherosclerotic disease, obesity, lower limb abnormalities, hearing or vision deficits, elevated temperature, anaemia, vitamin D deficiency and postprandial hypotension. 4,6,20,22,23 Most falls occur when a patient tries to stand up from a sitting position (orthostasis), tries to get out of bed, or tries to walk to the bathroom at night.…”

“…4,6,20,[23][24][25] Additional factors that increase the risk of falling include female gender, atherosclerotic disease, obesity, lower limb abnormalities, hearing or vision deficits, elevated temperature, anaemia, vitamin D deficiency and postprandial hypotension. 4,6,20,22,23 Most falls occur when a patient tries to stand up from a sitting position (orthostasis), tries to get out of bed, or tries to walk to the bathroom at night. 6,22 In a study of 825 patients admitted for rehabilitation following acute medical illness or a surgical procedure, a previous history of falls has been demonstrated to be the most important predictor of further falls.…”