Practical Psychiatry in the Long-Term Care Home : A Handbook for Staff

This is a practical book, aimed at providing training and guidance for staff members in long-term care facilities. The goal is to help staff understand and solve the wide range of psychiatric and behavioral problems which are encountered on a day-to-day basis. Numerous clinical illustrations are presented. This material is invaluable for all team members: nurses, physicians, social workers, psychologists, and occupational therapists. It is especially helpful for frontline health care aides who work most closely with the residents, and for supervisors and administrators. As a result, it also serves as a useful tool for teaching students. The emphasis is on training all members of the staff to provide the highest quality of care, in the most cost-effective and productive manner. Most of the authors have worked together at Baycrest (a large university affiliated, multilevel geriatric center, which has an international reputation for its excellence in the care of the elderly) or at other University of Toronto teaching hospitals.

The first edition of David Conn et alA 's handbook for staff concerning nursing home psychiatry, was published in 1992. It had 14 chapters and was good. A revised and expanded edition came out in 2001, and now we have a third, the title being slightly changed each time. Again, and to great advantage (especially in relation to the excellent case illustrations and family information sheets), the book has increased in length. There are now 20 chapters with a foreword.Surely A 'Practical Psychiatry in the Long-Term Care HomeA ' will be regarded as an essential resource in nursing homes and other aged care facilities all over the world. I have read or delved into a number of books concerning mental health problems in nursing homes and how staff can best cope with them. This beautifully presented offering is the most comprehensive, readable and useful. I agree with Ira Katz when he says in the foreword that everyone working in nursing homes and long-term facilities (including nurses, nursing aides, social workers, administrators and even non-clinical staff) should learn about mental health. As he says, A A"It is possible for nursing home residents to lead a good life, in spite of their illnesses and disabilities, if their mental health needs are metA A". Sadly, mental health needs are commonly overlooked or are addressed inadequately, which is why the International Psychogeriatric Association has formed a Task Force to foster radical improvement. This book, if used widely and appropriately, will help to catalyse change.Another group who will benefit by accessing the book will be the primary care doctors who have overall clinical responsibility for long-term care (LTC) residents. Much in these pages may be known to them only superficially at present. There is excellent discussion about behaviour management strategies, psychopharmacology, personality types, and interventions to deal with depression and other mental disorders. I think more detail on dementia (particularly fronto-temporal dementia) would have been warranted, and some of us would quibble with using the terms A 'clinical depressionA ' and A 'major depressionA ' interchangeably. There are differences between and within countries regarding alcohol use and resident involvement in decision-making in LTC facilities, yet there is little in the book that will not be useful for discussion and in education around the world.PAGE 1 of 2PAGE 2 of 2Book review by John Snowdon: (October 2007)PRACTICAL PSYCHIATRY IN THE LONG-TERM CARE HOME.A Handbook for Staff. Third edition.by David K. Conn et al.Publisher: Hogrefe & Huber, Toronto, 2007.International Psychogeriatrics 2008Reviewed by John Snowdon:There are two features that I hope will be modified for the fourth edition. Firstly, the index needs expansion. Imagine we are nursing aides and Mrs X is screaming and hitting out at people. We want help from Conn et al, but we do not find A A"screamingA A", A A"verbal outburstA A" or A A"aggressionA A" in the index. Agitation is listed under A A"Behavioural disturbances in dementiaA A". I could not find A A"PacingA A", A A"RestlessnessA A" or A A"WanderingA A", let alone A A"Simulated presenceA A".The other major omission, in my view, is a discussion of the role and importance of primary care doctors in LTC. General practitioners are the coordinators of aged care for their patients in most places. Some do it well and see themselves as contributing to team care in LTC facilities. They listen, talk and communicate with staff. Others are less good at aged care. Such a discussion would help staff to know how to shape the way attending doctors provide their input in nursing homes and elsewhere. In addition, hopefully, GPs too will read the book and be prompted to consider whether adaptation of their practice styles might be appropriate.In my view, this is more than a handbook to refer to when specific situations or problems are encountered. Given the wealth of illustrative cases, those aiming to educate staff (of various disciplines) will be able to work through the chapters in successive focussed discussion groups. Sometimes a facility-based nurse specialist will lead & coordinate this process, and in other places an A 'expertA ' will come from outside in order to lead discussions. Some of the illustrative cases will challenge beliefs and attitudes; controversy helps ensure that new ideas are retained even if not accepted as applicable.Finally, while acknowledging that newest is not necessarily best, the fact is that only one quarter of the bookA 's references & suggested readings are dated post-2000, some chapter-writers having more obviously examined the relevance of recent literature than others.Despite these caveats, I strongly recommend that all aged care facilities purchase the 2007 revision for their staff to use in education sessions and to refer to when deciding how best to deal with a problem or situation. Those who provide clinical advice (community teams and visiting GPs) and LTC administrators would also be wise to have the book readily available.