Drs Kim and Rovner succinctly set the stage for this month's issue of Psychiatric Annals on psychiatric care in the nursing home, guest edited by Ira B. Katz, MD, PhD, and Hugh Hendrie, MB, ChB. "Five percent of the population over the age of 65 currently live in nursing homes . . . 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 nursing homes is extraordinarily high, ranging from 80% to 90%."
We can look at it two ways, as potential consumers or as providers - either way, the conclusion is the same. If the fate of living out the last days, weeks, months, or years in a nursing home is dictated by current social and historical forces for many of our loved ones (and possibly ourselves), what can be done to preserve the optimal life quality in that situation, especially in light of the fact that psychiatric disorders appear to be one of the major limiting factors in that situation?
What can we accomplish under circumstances limited by dementia, chronic illness, and pain, as well as economics and the human limitation of caregivers who are left to do the best they can in a situation colored by progressive decline, suffering, and death? How can "life quality" be preserved in the face of this stark reality?
Indulge me in the thesis that happiness is largely a subjective state of mind, relatively independent of "reality," with the exception of extremes of pain, anxiety, depression, and other conditions that prevent one from focusing on the simple pleasures of life. By addressing psychiatric conditions in our patients, including those limited by the realities of nursing home living, we remove a major barrier to the enjoyment of what life has to offer, no matter what the limitations. This issue deals with the problems faced by a large and growing number of people who find themselves in a nursing home. The challenge is great, and while the situation of the patient may be limited, we can do a great deal to improve the quality of life during the time remaining for them.
In this month's issue, as introduced by Drs Katz and Hendrie, a range of issues concerning the epidemiology and management of major disorders, as well as major problems of behavior that present in nursing homes and a discussion of the effects of federal legislation on treatment, are covered in a comprehensive manner.