“…It was established because: All too often, where old people are concerned, medical, psychiatric and social emergencies present in such a way that it is not clear to which Unit the patient should be admitted in the first place. (Morton et al ., )…”
Reasons for the limited success of joint geriatric-psychiatric units might have included personalities of individuals, administrative boundaries separating geriatrics and medicine, unequal numbers of geriatricians and old-age psychiatrists, varying professional ideologies about the meaning of 'integrated' services, lack of reciprocity for each other's inpatients and lack of government support. Identified stumbling blocks need to be considered when planning joint clinical schemes. If current research indicates benefits of integrated wards for patients and their families, there needs to be ways to ensure that personal factors and fashions of management or government re-prioritisation will not lead to their premature termination.
“…It was established because: All too often, where old people are concerned, medical, psychiatric and social emergencies present in such a way that it is not clear to which Unit the patient should be admitted in the first place. (Morton et al ., )…”
Reasons for the limited success of joint geriatric-psychiatric units might have included personalities of individuals, administrative boundaries separating geriatrics and medicine, unequal numbers of geriatricians and old-age psychiatrists, varying professional ideologies about the meaning of 'integrated' services, lack of reciprocity for each other's inpatients and lack of government support. Identified stumbling blocks need to be considered when planning joint clinical schemes. If current research indicates benefits of integrated wards for patients and their families, there needs to be ways to ensure that personal factors and fashions of management or government re-prioritisation will not lead to their premature termination.
“…K ay et al [1966], Morton et al [1968] and the Scottish Health Services Council [1970] have put forward the case for such units whilst we have pointed to some of the shortcomings of this approach [Mezey et a!., 1968;Evans et al, 1971; also Arie, 1971],…”
The problem of misplacement of elderly patients was examined by survey of serial admissions to the geriatric and psychiatric departments serving an area of 200,000 population over the course of a year. Total misplacement was 9%, and 80% of misplaced patients went to the geriatric department where holiday admission (not offered by the psychiatric service) was a major factor predisposing to misplacement and where the patients were typically female and suffering from dementia. Misplacements to the psychiatric department represented 14.6% of admissions and were typically males with a short history of the present illness and more often had a past history of mental illness than similar patients correctly admitted to the geriatric department. We propose that a comprehensive geriatric service would be the best solution to the misplacement problem.
“…Collaboration between psychiatrists and geriatricians was crucial for providing care to older mentally ill people, although the physicians clearly placed the onus for service development on the psychiatrists. 46 Prior to 1970 there had been some successful joint ventures between psychiatrists and geriatricians, such as in Edinburgh (Fish and Williamson, 1964), Nottingham (Morton, Barker and Macmillan, 1968) and Cornwall (Donovan, Williams and Wilson, 1971), frequently infl uenced by the ideals of individual innovators (Arie and Dunn, 1973). Psycho-geriatric assessment units, initially proposed in 1950 47 had largely failed to become widespread.…”
Section: Collaboration and Dissent: Working With Geriatriciansmentioning
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