Five percent of the population of the United States over the age of 65 currently live in nursing homes. This percentage rises to approximately 25% for those 85 years and older. Approximately 20% to 50% of people over age 65 will live in nursing homes at some point in their lives. The prevalence of psychiatric disorders in residents of nursing homes is extraordinarily high, ranging from 80% to 90%. This fact is leading some authorities to conclude that nursing homes have replaced state mental hospitals as the primary source of residential psychiatric care for the elderly.
Yet, until recently, few residents in nursing home settings received any formal psychiatric care. Fortunately, under the impetus of regulations such as the Omnibus Budget Reconciliation Act (OBRA) of 1987 and the growth of interest in geriatric psychiatry as a specialty, this situation is gradually improving. Psychiatrists are increasingly being asked to provide consultation to nursing homes but, unfortunately, most psychiatrists did not receive formal training in nursing home care in their residency training program. It is hoped that the newly established psychogeriatric fellowship program, which does mandate rotations in nursing home settings for the prospective fellows, will increase training opportunities not only for the fellows, but also for psychiatric residents and medical students. Consequently, the editors of this edition of Psychiatric Annals felt that this would be an opportune time to provide an up-to-date review of psychiatric care in nursing home settings, discussing both the extent of the problem and management strategies.
In this edition, Drs. Kim and Rovner discuss the epidemiology of mental disorders in nursing homes. Dr. Streim discusses the impact that the 1987 OBRA regulations have had on psychiatric care in nursing homes. Drs. Samuels and Katz review therapeutic approaches to the very treatable but often missed problem of depression in nursing home patients. Dr. Sakauye as well as Dr. Hall and her colleagues discuss the management of the agitated, demented patient using both pharmacological and nonpharmacological methods. Drs. Lamberti and Tariot evaluate the care of the chronic schizophrenia patient, more and more of whom reside in nursing home settings. Finally, Drs. Class and Hendrie discuss the various roles psychiatrists can play in the management of the nursing home patient.
The provision of more and better psychiatric care to nursing home patients is a pressing issue. The practice of psychiatry in these settings can be both rewarding and stimulating. We hope this edition of Psychiatric Annals will instruct and thus encourage more practicing psychiatrists to undertake care for these patients.