How to take decisions with elderly people and to choose the best place for them. My conference at Alice Salomon Hochschule (Berlin), December 2010.

1. “Behavioural Disorders and Decision Taking.
Choosing the best facilities for Psychogeriatric
patients”.
First approach: dealing and living with a
psychogeriatric patient.
Elena Lorente
Teacher. University Complutense of Madrid (Spain).
Psychologist and Staff Coordinator. Geriatel Nursing Home (Madrid, Spain).
Independent Consultant in Elderly Care.

2. How professionals can consider
psychogeriatric patients?
• Professionals (Social Worker, Psychologist, Occupational Therapist,
GP., etc) have their own view.
• Facts about single patients are documented by tests and briefs.
– Are these tests complete?
– Do they provide enough information?
– Is it only valuable the numerical data?
• This single punctuation, is informing about the real status?
– What about daily life with a patient?
• We know little about that, except for information provided by relatives who
live with.

3. Reflection exercise #1
•Have we ever been in the situation of
knowing a number but not about patient’s
real life?
•Were we interested in simple facts and not
too much in punctuation?

4. Exercise #1
• Look up for an Activities of Daily Living or Patients’ Competence test or
inventory (Basic or Instrumental).
– E.g.: Barthel, Lawton, Katz, Spanish Red Cross, DEX, PCRS, etc.
• Choose some items and describe common life situations for patients attached to
those items.
• For Example:
– Responsibility for handling medication (item G from Lawton and Brody Scale).
• Is responsible for taking medication in correct dosages at correct time.
– “Always cares about her pills, but not for oxygen, she remains asleep with it for hours, she
takes very long naps”.
– “My father is very obsessive with his medication, it is his main thinking topic”.
• Takes responsibility if medication is prepared in advance in separate dosage.
– “One patient had a digital clock close to the medication box, where all dosages were
separated. She took night’s medication one morning and she almost collapse”.
– “I am very forgetful so I prepare my medication in this box and just take it”.
• Is not capable of dispensing own medication.
– “Doctor, please, there are too much pills, I am afraid they all are not mine, but the garnet pill
and this white pastille”.
– Hiding pills in the bra or in a shoe.

5. Patients’ daily life is very complex.
Reflection Exercise #2
•Patients difficult to handle, or caregivers
with little social abilities?
• Perceived burden matches real burden?
• Have you ever meet a caregiver that did
not pay attention to professional advice?

6. Exercise #2
• Using those situations described, try to write
how a caregiver would feel.
• Also try to estimate the load a caregiver could
perceive.
• Think about how could all be linked to cognitive
impairment.
• And how these facts are sometimes related to
behavioural disorders.

7. Conclusions = why this duty?
• That was only done considering functional and
independence abilities.
– What about behavioural disorders?
• We will practise with behavioural disorders in December
during the semminar.
• Caregivers and relatives ask for professional
advice.
– As professionals, we must take the right decision, that
might be assignment to any resource.
• Which one is most suitable having these features?