Palliative Care, Inpatient Psych Urged to Consult

By Dixon, Bruce K. | Clinical Psychiatry News, May 2007 | Go to article overview

Palliative Care, Inpatient Psych Urged to Consult


Dixon, Bruce K., Clinical Psychiatry News


SALT LAKE CITY -- Collaboration between palliative care and the psychiatric inpatient unit can greatly improve mental health care for nursing home residents with behavioral and psychological symptoms of dementia, according to presenters at the annual meeting of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association. "Dementia is the most frequent reason for nursing home admissions, and nationally 80% of nursing home residents who are in need of psychiatric services fail to receive them," said Dr. Janet Bull, vice president of medical services for Four Seasons Hospice and Palliative Care in Flat Rock, N.C.

Four Seasons has a contractual relationship with every nursing home in Henderson County.

Nationwide, half of nursing homes do not have access to adequate psychiatric consultation, said Dr. Bull, who is board certified in both hospice and palliative care and ob.gyn.

In addition, mental health funding is being cut and the Deficit Reduction Omnibus Reconciliation Act guidelines limit pharmacologic treatment for psychotic conditions, she explained.

Untreated psychiatric disorders result in decreased functioning, poor quality of life, and increased mortality, and this leads to high use of psychiatric units by nursing homes. "Very often, we don't see these patients until they end up in the ICU in a state of crisis," Dr. Bull said.

So she and her colleagues forged a collaboration with the medical psychiatric unit of Park Ridge Hospital, in nearby Hendersonville, N.C., to create an interdisciplinary team consisting of the psychiatrist, a psychiatric nurse practitioner, a nurse, a social worker, a music therapist, an activities therapist, and the hospital chaplain.

Four Seasons team members included a palliative care physician (Dr. Bull), a palliative care nurse practitioner, and administrative support.

Last year, there were 308 admissions to the hospital medical psychiatric unit, of which two-thirds were related to behavioral and psychological symptoms of dementia (BPSD), Dr. …

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