Dialogue Volume 12 Issue 3 2016 - Page 36

practice partner “Having a dementia should not be a barrier to the treatment of recognized serious mental illness” The behaviours that the patient had demonstrated earlier while he was at a retirement home – such as being wide awake every night, yelling, walking the hall, entering other seniors’ rooms, falling and aggression with staff – while possibly attributable to a behavioural syndrome associated with dementia, were much more likely to be due to mania expressed in an individual who happened to have a dementia. This is a crucial distinction, said the GLTCRC, as senior supports in the community, be they retirement homes or long-term care homes, are not equipped in staffing, expertise, or physical layout to manage individuals with mania. His behaviours in terms of aggression persisted into the long-term care setting. The documentation on the Community Care Access Centre (CCAC) forms for long-term care did not accurately reflect the degree of behavioural disinhibition he was exhibiting, said the Committee. A striking aspect of the notes in the retirement home and long-term care settings is the repeated documentation by personal support workers and nursing staff of aggression and physical violence, with workers being punched and struck on a regular basis, said the Committee. Based upon the notes reviewed, th e treating physicians appeared to not recognize the seriousness of the demon- 36 Dialogue Issue 3, 2016 strated behaviours. The Committee noted that there appeared to be reluctance on the part of all health-care providers to send the patient to the emergency department for assessment of his behaviours. The Committee interpreted his behaviors as symptoms of mania in an individual with a known bipolar disorder Type 1, who happens to also have a dementia. Having a dementia should not be a barrier to the treatment of recognized serious mental illness, stated the Committee. The patient should have been sent to the emergency department for an urgent psychiatric assessment. The Committee also recommended that the Ministry increase support to the primary care and long-term care sectors caring for the dementia patient with a serious mental illness. Individuals with pre-existing serious mental illness are a challenge for primary care clinicians used to working with dementia patients. Finally, the Committee also recommended the Ministry develop a provincial strategy and implementation plan to improve access to specialized senior’s mental health. The Committee remarked that it is too difficult to access crisis mental health support for seniors and the current level of geriatric psychiatry in-patient beds is insufficient to meet the demand. MD