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