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PubMed1978

Crisis intervention and the prevention of institutionalization: an interrupted time series analysis.

In the context of the community mental health movement in Illinois, the evolution and development of a crisis intervention program aimed at avoiding state hospitalization and bringing more appropriate and efficacious resources to bear on the difficulties of the individual and/or family is described. This intervention program is characterized by a more active-seeking style of delivering mental health services. With the novel application of interrupted time series analysis to both the targeted and matched nonequivalent control communities the efficacy of this more active intervention in reducing the number of state hospital administrations diagnosed as "mentally ill" is highlighted. The cost/benefit to the taxpayer is also discussed.

Community Mental Health Services↗
PubMed1981

Reliability of the behavior problem checklist with institutionalized male delinquents.

Interrater and 2-week test-retest reliability coefficients were determined for subscales of the Behavior Problem Checklist on 50 males incarcerated in a state receiving facility for delinquent adolescents. Raters were 22 dormitory counselors, 2 of whom rated each child after 1 week and again after 3 weeks of observing the boys. Interrater reliability ranged from .06 to .68 on the various BPC subscales and was .50 overall, reflecting wide variation in the agreement of raters in rating boys on different dimensions. Test-retest reliability coefficients for the same rater at 2-week intervals were higher (.71 overall) and also varied among subscales. Raters were able to agree best on aggressive, acting-out behaviors. Other personality dimensions tapped by the BPC were rated with less reliability in this particular setting.

Adolescent↗
PubMed1992

The development of de-institutionalization in Europe.

In this article movements from institutional to community care for psychiatric patients in various European countries are discussed. Programs considering the welfare of afflicted persons, diminution of psychopathology and improvements of functioning, as well as the costs of deinstitutionalization are reviewed. The review first deals with the prevention of admissions prior to referral to inpatient facilities, looking at the role of general practitioners and ambulatory services in preventing admissions. Secondly, alternatives for hospital care are considered. Thirdly, consideration is given to the possibilities of shortening the time patients stay in hospitals. Next, experiences in discharging long stay patients to alternatives for continued care in psychiatric hospitals are reported. Finally, the advantages are shown of integrating all regional mental health services under one administration. Selected national policies are described as well as the success of present programs are discussed. With few exceptions only European studies are reported.

Community Mental Health Services↗
PubMed1991

[Prevalence, circumstances and consequences of falls in institutionalized elderly; a pilot study].

Falls are frequent among elderly people, and are a still-underestimated medical problem with respect to causes and consequences. The present epidemiological study describes the experience from a 79-bed nursing home in the city of Zürich, regarding frequency, circumstances and consequences of falls. Over half of residents of the studied nursing home fell at least once during the study period of one year, and one third even suffered 3 or more falls. Dizziness, tripping and slipping were among the reasons given for falling. However, in one third of the cases the person involved was not able to specify the cause of the fall. Every fifth fall to injury or fracture, and every tenth fall to fall-related pain. The fall-related overall morbidity therefore amounted to 35.3%.

Accidental Falls↗
PubMed1994

The everyday experience of an institutionalized sex offender: an idiographic application of the experience sampling method.

The Experience Sampling Method (ESM) is a novel assessment strategy that allows random sampling of thoughts, affects, and behaviors. In ESM studies subjects wear beepers that signal at randomly generated, preprogrammed times at which subjects fill out a questionnaire containing items related to current activity, location, thought content, mood states, etc. The ESM was used to examine the relationship between mood states and thought content in a hospitalized sex offender. The patient exhibited a very high frequency of thoughts with sexual content, as well as thoughts indicative of anger against women, personal inadequacy, and distress. He appeared to be a poor judge of his state of optimal well-being. Whereas he considered support from others to be related to optimal well-being, it was actually sexual thoughts about a woman that were associated with his optimal well-being. The present case study illustrates the value of the ESM in the study of complex thought-affect-behavior relationships.

Activities of Daily Living↗
PubMed1989

The general health questionnaire (GHQ) as a predictor of hospital care and mortality in the non-institutionalized elderly.

The general health questionnaire (GHQ) and its relation to hospital care and risk of death were studied prospectively in the total elderly population living in a community in northern Finland. Of the eligible elderly, 982 or 85% took part in the study, returning the GHQ. A high score on the questionnaire was considered an indicator of minor psychiatric illness. It was found that the average number of hospital days, calculated per person-years, was twice as high in the high scorers than in the low scorers. When the effects of age and certain diseases were controlled for, the high scoring men and women had a significantly higher risk of being hospitalized for at least ten days over a five-year period than the 0-1 scorers. The risk ratio was 1.6 and 1.4 for men and women, respectively. The ten-year mortality was significantly higher in the high scoring men and women than in the low scorers, when the effects of age and certain diseases were controlled for. The risk ratios for both men and women were 1.4. The GHQ was found to predict hospital care, physician visits, home services and mortality in a representative group of rural elderly people.

Aged↗
PubMed1991

Accidents in the institutionalized elderly: a risk analysis.

Among a total of 4,862 admittances to a Swedish geriatric hospital and its associated nursing homes, 827 accidents occurred in 588 patients during one year. The purpose of the present study was to establish the direct causes of these accidents and to identify possible risk factors. Information was collected from medical records, interviews with patients and staff, examination of the mental and physical state of the patients, and through reconstruction of the accidents. The investigation embraced 270 patients with 308 major accidents (fractures, sprains, open wounds, concussions and injuries to ligaments), and 318 patients with 519 minor accidents (bruises, contusions, abrasions and minor burns). Injury-free patients with nearest lower bed number in relation to patients with major accidents formed a control group. Patients with previous injuries, balance disturbances, and polypharmacy were at high risk, and intrinsic factors such as dizziness and impaired balance proved to be more significant as direct causes for the occurrence of accidents than environmental factors. The estimated risk for a patient with all these risk factors to have an accident during one year was 94%.

Accidents↗