Friends Hospital, a renowned leader in the provision of mental health services, has a program specifically dedicated to older adults.
Geriatric psychiatrist William Uffner leads a team of nurses, therapists, dietitians, counselors, educators and social workers at the hospital, on Roosevelt Boulevard in Northeast Philadelphia. All staff, according to Dr. Marc Rothman, the hospital’s chief medical officer, are sensitive to family, social and economic dynamics, as well as to geriatric psychiatric and medical issues.
“What’s remarkable to me is how psychologically resilient so many older adults are,” Dr. Uffner says. “Emotional wounds heal like physical wounds: they need to be cleaned, ventilated, provided with therapy and some adjustments. Preserve each individual’s integrity and help them figure out how they will continue to grow.”
The small size (192 hospital beds) is designed to create an intimate setting that builds positive relationships, Rothman says, where “you can be more yourself.” Care is individualized and in small groups, he adds, so patients and staff know each other.
Lifelong psychiatric disorders often intensify with age, explains Dr. Uffner. Furthermore, when mental illnesses coincide with strokes or diabetes, they may become even harder to treat. This makes the medical sophistication and motivation of Friends’ psychiatric nurses all the more valuable, he says.
Rothman says that about 15 percent of dementias are reversible — those caused by treatable medical problems or conditions that call for changes in how they’re managed. He emphasizes the importance of a complete physical evaluation before writing off mental confusion to aging or dementia.
Rothman says it’s crucial to understand the multiple biological, psychological and social dimensions of the problem in order to properly treat physical, emotional and environmental elements. For instance, if a patient’s main problem is “wandering,” that situation might best be managed by safety-proofing the surroundings. But that’s different from circumstances in which the patient is hallucinating and abusive, which may require medical intervention, including medication.
Family and patient education, counseling and support networks are vital tools for coping with and caring for people with mental illness. Being informed about illness, getting tips on providing care and speaking with others who understand decreases the crises at home and the need for hospitalization.
A tipping point at which many people can no longer care for a loved one at home may be a fall, inability to sleep at night or toileting problems.
But the biggest change that may require hospitalization, warns Rothman, is not in the patient with dementia. Often, it’s in the health or availability of the caregiver.
Half of the caregivers for people with dementia are themselves frail and depressed, he says. They overwork and mask their own difficulties. Before it’s too late, these caregivers need support.
For information on support to caregivers: PCA Helpline at 215-765-9040.