Intra‐Hospital Transfer: Effects on Chronically Ill Psychogeriatric Patients

Abstract

Since the Vermont State Hospital was approaching a major transition period, it was decided to study systematically the effects of intra-unit and inter-unit transfer on its psychogeriatric patients. Ten patients were assessed by means of four standardized measures in the intra-unit study, specifically investigating the effects of integrating wards previously devoted either to chronic or to acute psychiatric illness. Twenty-five patients from a specialized geriatric unit were evaluated, by separate investigators, with respect to changes occuring as a result of their transfer to regional mixed units. The critical incident log, the problem classification form, and the clinical global impression showed some changes, for which there were several possible explanations. None of the changes was as dramatic as predicted by staff members holding divergent views prior to the study. The optimists predicted a "blossoming" of the psychogeriatric patients in the mixed, regional units, whereas the pessimists prophesied dire consequences. The group of patients studied was not completely homogeneous with respect to the effect to transfer. Clinical assessment after transfer could be relied on to detect improvement in some of these psychogeriatric patients and deterioration in others. Some understanding of the complexity of the multifactor determinants of change developed along with increased cooperation among the investigators and the nursing staff. A middle ground of mutual respect for fresh ideas and an appreciation for years of experience was reached.

Unexpected consequences of deinstitutionalization of the mentally disabled elderly

“…Resource richness did not correlate with posttransfer outcome in this study. Similar results have been reported by other researchers (Raasoch et al, 1977).…”

“…The degree of difference between the demands and routines of pre-and posttransfer environments have been strongly implicated in the short-term outcome of relocated patients. A new environment which makes few novel demands on relocated elderly residents has not been found to affect the functioning among patients who are not in a high risk category (Bourestom & Tars, 1974;Gutman & Herbert, 1976;Lieberman, 1974;Pablo, 1977;Raasoch et al, 1977;Watson & Buerkle, 1976). Studies which have reported little or no differences between pre-and posttransfer functioning have primarily looked at programs which moved patients en masse and which maintained staff, daily routine, and patient groups relatively intact.…”

“…When discrepancies between old and new environments are marked, and changes are experienced as improvements, elderly persons (other than those with high risk characteristics) tend to improve following transfer (Carp, 19671 Goldfarb et al, 1972;Lieberman, 1974;Novick, 1967;Pihkanen & Lahdenpera, 1963;Raasoch et al, 1977;Whittels & Botwinick, 1974;Zweig & Csank, 1975. A good example is the study of Zweig and Csank (1975) which followed 350 elderly patients who were moved from an aging facility to a newly con.…”

Mortality among Elderly Psychiatric Patients: Basis for Preventive Intervention

“…Slightly less than 20 percent of the patients died in the first month, with the remainder dying over the subsequent 11 months. The present study showed considerably lower first-year mortality rates, averaging about 18 percent for the patients aged 60-69 and 38 percent for those aged 70-99. In contrast to this picture, studies of intra-and inter-institutional transfer of the elderly under controlled conditions have demonstrated a much lower mortality experience (5)(6)(7)(8)(9). These studies have indicated that individualized preparation of these patients to reduce the unfamiliarity of the new environment and to provide continuity of contact with the program staff and family can have a significant effect in the reduction of mortality.…”

The Context of Change: Disorientation Following Intra-Institutional Relocation

“…In their study of the effects of intrahospital transfer on chronically ill psychogeriatric patients, Raasoch, Willmuth, Thomson, and Hyde (1977) found that patients transferred within a given unit were virtually unaffected. While comparison of problem classification forms before and after the move for the 23 patients transferred between units revealed no significant differences in the totals reported, examination of problem areas with scores that changed more than 25% was of particular interest.…”