THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Wednesday, July 13, 1994 TAG: 9407120112
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: By DEBRA GORDON, STAFF WRITER
LENGTH: Long : 164 lines
IT WAS CHRISTMAS, and for the first time in her 84 years, Alice O'Connor ignored the holiday. She didn't send cards. Didn't buy presents. Just disappeared into her room at her granddaughter's house and sat.
It frightened her granddaughter, Sandy Driscoll, 27, so much that she took O'Connor to a therapist, who recommended the older woman be admitted to Chesapeake General Hospital's geropsychiatric program.
The diagnosis: depression. It's a common disorder in older adults, with up to 12 percent of the over-55 population exhibiting some signs of depression.
And while depression, along with other mental disorders such as paranoia, bipolar disorder and anxiety, is as treatable in an older person as a younger one, it's often more difficult to treat because of co-existing physical problems like diabetes, heart disease, arthritis and stroke.
And so in Hampton Roads, as well as across the country, specialized psychiatric units are springing up to treat this expanding population. Two inpatient units and an outpatient unit opened this spring in Virginia Beach across the street from each other, and a partial hospitalization program began in February in Chesapeake.
They join Chesapeake General's 24-bed inpatient unit, which has served the region's elderly since 1989, and the Virginia Beach Community Services Board's day treatment program, which treats that city's indigent and uninsured elderly on an outpatient basis.
``The problems of an older person with mental health difficulties aren't different from that of a younger person,'' said Donna Cohen, director of the University of South Florida's Institute on Aging in Tampa. ``They're just more complicated. The beauty of a geriatric specialization is that you're working with people with more than one problem, and geriatric psychiatrists can understand the interacting disorders.''
Up to 35 percent of patients referred for dementia, for instance, actually are suffering from some other mental illness, usually depression, Cohen said.
Others may have medication-induced disorders, resulting from the interactions of the various drugs they take.
At Chesapeake General Hospital's new day unit, for instance, a full-time staff nurse regulates patients' medications and teaches them how to better monitor their physical needs and health.
``It's not a new population that psychiatric hospitals are treating,'' said Priscilla Hulson, program administrator for Virginia Beach Psychiatric Center's 10-bed inpatient unit, ``but because of the rise in this population, there's more need, and so the psychiatric community is getting more specialized as they try to better meet the needs.''
Patients are referred by their physicians or families or are self-referred. Many come from area nursing homes, which have a disproportionately high number of residents with mental problems, said Cohen, who estimates that 40 percent to 80 percent of nursing home residents suffer from some psychiatric disorder, with only about 5 percent receiving treatment.
``So these programs are really an opportunity to help,'' she said. ``Treatment of depression in nursing homes is a major challenge; if you can treat the depression, then you maximize the quality of life. The resident starts eating better, the outcomes are better and the overall medical costs go down.''
Beginning at age 55, our lives enter a period of transition. There's retirement, which may bring a loss of self-esteem with the loss of job status; physical changes, including the loss of a youthful appearance, or debilitating problems such as arthritis and heart disease; and the loss of loved ones, including spouses, parents, friends and siblings.
Often, older people can't keep up with the losses, said Suzanne Storms, program coordinator of Chesapeake's day unit. They become angry at the changes, and, fearful of how the world will react to their anger, turn it inward onto themselves, often becoming depressed.
Once depressed, they may neglect themselves physically - stop eating, stop taking medications, stop exercising - thus beginning a rapid downward spiral.
Alice O'Connor, for instance, stopped eating. By the time she entered the hospital, she weighed 76 pounds.
Even after spending three weeks on the inpatient unit, and the past three months on the day unit, she remains painfully thin, the bones of her wrists poking through her crepey skin.
But the depression is gone, said her granddaughter, thanks primarily to the therapy she's receiving three days a week.
``It keeps her busy, she tells me about her day. It keeps her mind active,'' Driscoll said. It helps by giving her a strong structure to her day, Storms noted.
An adult day care center also provides structure for senior citizens, Storms said, but it doesn't include the same kind of individual, goal-directed treatment plan her unit does.
It's an important difference, because failure to distinguish itself from an adult day care setting could mean revocation of Medicare reimbursement, a geropsych unit's prime funding source.
Maryview Medical Center in Portsmouth had a similar day geropsych program until a few months ago, when it closed because it could no longer get Medicare reimbursement.
After a year of reimbursement, said Louise Eidson, the hospital's vice president of marketing and physician services, Medicare classified the unit as a custodial program like adult day care and cut off reimbursement.
It's a loss felt keenly by family nurse practitioner Veronica Griffith of the geriatric assessment and resource center at Portsmouth Family Practice. It pains her to send her elderly patients to Chesapeake or Virginia Beach now for the care they used to get in Portsmouth.
But it's important that they be in that geriatric psych setting, she said, adding: ``Older people need to be with other people like themselves vs. one-on-one therapy. They need that support they get out of that interaction.''
It's 9:45 a.m. and the nine patients of Chesapeake's day unit are gathered in the bright, sunny activity room of the small building across the street from the main hospital.
Some are peering through large magnifying glasses as they scan the morning newspaper. They're searching for an interesting article to read to the group and discuss as part of their current-events session.
Throughout the day, two mental health therapists, augmented by Storms and the unit's nurse, will conduct sessions on nutrition, exercise, socialization, medications, loss and grief therapy.
Every activity is designed with specific goals in mind. The morning's current-events session, for instance, helps shift the elderly person's focus from himself to the world at large.
Most geropsych programs operate similarly, using therapies geared toward their special patients.
At Virginia Beach Psychiatric, for instance, music therapy plays a big role with elderly patients, Hulson said, because music usually played such a large role in their lives.
Tidewater Psychiatric Institute's Virginia Beach facility, which opened its 12-bed inpatient unit and 30-patient day unit in April, redecorated the adult wing with flowered wallpaper borders, clocks in all the rooms and framed prints on the walls. It's designed to appeal to the patient's senses, said Sheila Cannon, director of nursing, because the elderly are so often sensory deprived.
But there's more to a quality geropsych unit than just pretty wallpaper. Kathleen Bullock O'Connor, director of the Virginia Beach Community Services Board's adult day program, warns families to look for staff specially trained in geriatrics, for inpatient units physically isolated from other units in the hospital, for handicapped bathrooms and bedrooms, and for separate programming for the older population. ILLUSTRATION: Illustration by SAM HUNDLEY
PHOTO BY RICHARD L. DUNSTON
Graphics
DANGER SIGNALS
Signs of depression in an older person:
Feeling blue
Sleeplessness
Sleeping during the day; awake at night
Diminution or increase in appetite
Agitation
Memory loss
Constipation
Confusion
WHERE THE UNITS ARE
Chesapeake General Hospital has a 24-bed inpatient geriatric
psych unit and a free-standing partial hospitalization program with
a capacity of 20. 482-6143
Virginia Beach Psychiatric Institute on First Colonial Road has a
10-bed geropsych unit. 496-6000
Tidewater Psychiatric Institute in Virginia Beach has a 12-unit
geropsych unit and a 30-person day program. 481-1211.
Virginia Beach Community Services Board has a day geropsych
program for older adults. 496-6747
by CNB