CASE STUDY

Case Study

Case Study

Outline

In this case-study the relevance of psycho-social interventions for providing end of life care in the terminal phase of life of psycho-geriatric patients with functional-psychiatric co-pathology is described. The know-how, interventions and facilities such as available in a reactivation unit in a 'psychiatric-skilled' Dutch nursing home, were highly relevant to tune end of life care to the needs and abilities of the patient. The application of the four main-dimensions of the method of Dynamic System Analysis (particularly Cognitive functions, Psychological functions, Social context and Biology) can stimulate professionals to use an integral perspective both to the psycho-social needs of terminal psycho-geriatric patients and their relatives and to the biological aspects. To establish the value of the DSA method for providing end of life care to psycho-geriatric patients with functional-psychiatric co-pathology scientific research is recommended to determine the prognostic profile of patients who benefit most from an actual end of life care program.

Introduction

Due to ageing of the Western population, there is a growing prevalence of chronic psycho-geriatric disorders like 'dementia of the Alzheimer type' and 'vascular dementia'. The genuine, though multifarious cognitive function disorders of psycho-geriatric patients co-occur often with mood and behavior disorders as well as social problems. In case of end of life care, this complex co-pathology determines the wide range of psycho-social needs of individual psycho-geriatric patients and their social environment. In our psycho-geriatric reactivation program we are confronted with the special aspects of end of life care for this type of patient. About 25% of our total reactivation population dies during the course of the program; according to literature this percentage is 13-32%. We found out that the method and expertise used in the reactivation program were relevant in arranging the end of life care of these patients in their terminal phase of life.

In this paper we will focus on our experience with end of life care of patients who deceased during the course of the reactivation program. The psycho-geriatric reactivation is conducted in a Dutch 'psychiatric-skilled' nursing home. First we will present a case-study followed by an explanation about our reactivation program and the underlying method Dynamic System Analysis (DSA). We will conclude with a discussion about the practice implications of DSA for end of life care of psycho-geriatric patients with functional-psychiatric co-pathology.

Case-study

Case history

Patient Olive was a 91-year-old lady. In the early eighties she had suffered from depression, for 3 years she had vivid nightmares related to second world war experiences. Three weeks before admission she suffered from a bronchopneumonia. After her protracted recovery Olive no longer wanted to go to the day-clinic; she stayed in bed almost all of the day. To the home-care team Olive showed increasing verbal and physical aggression. They had the impression that Olive didn't sleep much during the night. Her food and liquid intake was also below the minimum. She was admitted to the psycho-geriatric reactivation program because the circumstances and supportive system at home became insufficient. Olive agreed to ...