A psychiatric intensive care unit for older adults

Background : The role of psychiatric intensive care units is well established for the general adult psychiatric population, but these units are often less suitable for the elderly psychiatric population. An increase in the number of behaviourally challenging demented male patients in the elderly psychiatric admission wards of one Scottish health region created an opportunity to develop a psychiatric intensive care unit for elders with these problems (PICUe). Method : Prospective survey of activity in the PICUe during 2005, using routinely collected data. Results : 14 male patients, mean age 70 years, were admitted to the PICUe on 17 occasions during 2005, with 76% detained under the Mental Health (Scotland) Act, 1984. The majority (43%) of patients had a primary diagnosis of Alzheimer's dementia, 21% with vascular dementia. The main transfer reason was resistive behaviours, with persistent physical aggression being the next most common reason. The average mini-mental state score was 14/30, and the mean duration of patient stay in the PICUe was 46 days, with 71% of admissions discharged from the unit during the evaluation period. Benefits were noted for referring clinical teams and for patients. Conclusions : The results suggest that a regionally-based psychiatric intensive care unit for older adults can serve a useful function in the management of disturbed elders who are otherwise difficult to manage within the current hospital-based elderly psychiatric care facilities.