Mr. Thompson is a 78-year-old man with multiple medical comorbidities admitted to an inpatient geriatric psychiatric unit for new-onset paranoid ideation, agitation, and wandering behaviors. Caring for older adults such as Mr. Thompson with both psychiatric and complex medical issues requires an interdisciplinary approach that considers how his medications, chronic illness, family involvement, discharge planning, and follow-up impact his mental health and well-being. This paper will discuss medication adjustments, specialist collaboration, therapeutic modalities during hospitalization, and actions necessary before discharge to ensure a safe transition back into the community.
Medication Management
Mr. Thompson currently takes donepezil for Alzheimer’s, which can precipitate psychiatric issues such as agitation or psychosis. The dose could be reduced to see if it improves his symptoms (Ballard et al., 2020). However, completely stopping it could worsen his cognition. His uncontrolled blood sugars may also contribute to agitation, so monitoring glucose and adjusting diabetes meds is warranted. Adding an antipsychotic such as risperidone on a short-term basis may help manage paranoid delusions and aggressive outbursts. Still, the dosage must be conservative in the elderly, and adverse effects must be monitored. Drug interactions between psychiatric meds, diabetes meds, and anti-hypertensives could occur, so consulting a pharmacy for an evaluation is essential (D’Alessandro et al., 2022). Optimizing control of medical conditions through close collaboration with geriatricians and neurologists while minimizing unnecessary medications can improve Mr. Thompson’s mental health.
Interdisciplinary Collaboration
Given his complex presentation, Mr. Thompson would benefit significantly from input across multiple disciplines. Psychiatry guides managing agitation and paranoia. Geriatric medicine addresses chronic diseases such as diabetes and prior stroke (Kojima et al., 2020). Neurology can assess for the progression of Alzheimer’s or new events. Pharmacy performs medication reconciliation and teaches proper administration. Nursing staff play a crucial role by continually setting Mr. Thompson’s behaviors, mood, and responses to interventions. Their regular documentation and reporting during shift changes provide up-to-date information to guide treatment adjustments. Nurses also offer essential one-on-one care, including administering medications, assisting with activities of daily living, and monitoring Mr. Thompson’s safety.
Social workers connect his family members to counseling and education on Alzheimer’s to help them process feelings and prepare for caregiving needs. They also arrange home health services for continued support post-discharge. Physical, occupational, and music therapists use sensory-based modalities such as games, exercise, and singing to stimulate cognitive functioning and cope with paranoia (Janssen, 2022). To promote coordinated care, Mr. Thompson’s care team convenes weekly family meetings to discuss progress and discharge plans. Interdisciplinary rounds each morning allow nurses, doctors, therapists, and social workers to set patient-focused daily goals collaboratively. Ongoing communication facilitates safe transitions home with outpatient providers.
Therapeutic Interventions
Non-drug approaches are vital for Mr. Thompson. Cognitive behavioral therapy from psychiatric providers can address paranoid beliefs. Occupational therapy helps retain functional cognition through puzzles, handicrafts, and music (Mashinchi, 2023). Physical therapy builds strength and balance to prevent injuries from falls and wandering, conducted cautiously considering Mr. Thompson’s prior stroke. Access to outdoor spaces or indoor nature and exercise reduces restless behaviors. Pet therapy comforts anxious patients, so allowing Mr. Thompson to interact with a friendly dog could help ease agitation. Nursing staff can use validation therapy to meet Mr. Thompson at his emotional level rather than confronting misperceptions. Consistent routines with adequate sleep and wake cycles and nighttime interventions such as warm beverages or gentle walks mitigate sundowning (Miller, 2023). Removing triggers such as excess noise and employing one-to-one de-escalation if he becomes combative protects patient safety and staff well-being.
Discharge Planning and Follow-up
Before discharge, Mr. Thompson’s care team should perform a home safety evaluation, given his risk for injury due to forgetfulness, instability, and wandering behaviors. Fall precautions such as railings and adequate lighting should be in place. All medications need to be locked away securely. Supervision is necessary 24/7, including in-home caregiving or placement at an assisted living facility (Niehoff et al., 2022). Easy-to-follow medication boxes with reminders facilitate compliance. Follow-up appointments should be made with outpatient psychiatry within a week of discharge to monitor paranoid thinking, building on the rapport established with inpatient psychiatric providers.
Similarly, prompt neurology and primary care visits ensure oversight of chronic diseases to reduce re-hospitalization. Home health services such as physical therapy sustain functional improvements during the hospital stay. Providing Mr. Thompson’s family and friends with educational resources about Alzheimer’s enables their ongoing participation in care. Utilizing support groups for Mr. Thompson and his loved ones facilitates the transition home.
In conclusion, caring for complex older adults such as Mr. Thompson with co-occurring medical, neurological, and psychiatric issues demands expertise across specialties. They provide patient-centered, integrated care with medication adjustments to control symptoms while avoiding overtreatment, therapeutic modalities to reduce agitation, thorough discharge planning with ongoing home support, and education to enable family members to optimize outcomes even in complex cases. With an interdisciplinary approach to Mr. Thompson’s unique needs while supporting his loved ones, the care team facilitates successful management during hospitalization and a safer discharge back home.
References
Ballard, C., Kales, H. C., Lyketsos, C., Aarsland, D., Creese, B., Mills, R., Williams, H., & Sweet, R. A. (2020). Psychosis in Alzheimer’s Disease. Current Neurology and Neuroscience Reports, 20(12). https://doi.org/10.1007/s11910-020-01074-y
D’Alessandro, C., Benedetti, A., Di Paolo, A., Giannese, D., & Cupisti, A. (2022). Interactions between Food and Drugs, and Nutritional Status in Renal Patients: A Narrative Review. Nutrients, 14(1), 212. https://doi.org/10.3390/nu14010212
Janssen, M. (2022). A Sensory-Based Toolkit For Health Management Of Patients With Aggressive Behaviors In Acute Care. Occupational Therapy Capstones. https://commons.und.edu/ot-grad/501/
Kojima, T., Mizokami, F., & Akishita, M. (2020). Geriatric management of older patients with multimorbidity. Geriatrics & Gerontology International, 20(12), 1105–1111. https://doi.org/10.1111/ggi.14065
Mashinchi, G. (2023). Handicraft art leisure activities and cognitive reserve. The Clinical Neuropsychologist, 1–32. https://doi.org/10.1080/13854046.2023.2253993
Miller, B. (2023). Providing Optimal Resident Sleep Hygiene in Assisted Living Communities; Opportunities for Design and Operation Teams to Collaborate and Share Their Unique Knowledge. Architecture Masters of Science Program: Theses. https://digitalcommons.unl.edu/archthesis/189/
Niehoff, K. M., Muscarella, J., Knostman, M., Sullivan, M., Gani, A., Lim, H., Calhoun, A. R., Young, B. T., Vasilevskis, E. E., Mixon, A. S., Choma, N. N., Gillihan, K. G., Sachs, A. L., Ivory, C., Maxwell, C. A., Stolldorf, D. P., Horr, T. B., & Kripalani, S. (2022). Hospital at home: Development of pharmacy services. American Journal of Health-System Pharmacy, 79(22), 1981–1987. https://doi.org/10.1093/ajhp/zxac225
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