Psychiatry in the Geriatric Hospital: Its Goals and Limitations

Dr. M. Feder, Hôpital de Gériatrie, CH-1200 Geneva (Switzerland) It is widely accepted that pathology in the aged nearly always comprises a considerable psychiatric component. It is paradoxical that despite an acknowledged interdependence of the physical and psychiatric aspects of care most geriatric facilities separate the two disciplines. At the Geriatric Hospital in Geneva, Switzerland, to reach the major goal of offering comprehensive medical service to the aged, the medical staff consists of internists and psychiatrists sharing equal responsability and enjoying equal status. This principle is personified in the medical director of the hospital who has training in both internal medicine and psychiatry. In the Hospital opened 3 years ago only 200 of the 320 beds are occupied due to the difficulty of recruiting nursing personnel. We admit all aged patients with both physical and psychiatric disorders placed on mixed floors. The average age of the patient is 79. The patients are admitted for diagnosis, treatment and rehabilitation – with the exception of those needing surgery or the agitated, ambulatory patient in need of protection (i.e. closed facilities) 20–25 patients are admitted weekly while the average length of stay is 46 days. 2 years ago we opened a Day Hospital which offers ongoing treatment for over 80 patients. Recently the Day Hospital is also being used as a rapid diagnostic centre. Closely connected with the Hospital is the Geriatric Centre assuring the coordination of all geriatric services in the Canton of Geneva as well as providing direct extramural psychogeriatric care. This Centre refers patients to the Hospital, but the majority, 60%, of the hospital patients come from 1 This paper has been read at the meeting of the European Clinical Section of the International Association of Gerontology, held in Manchester, 1974. Feder 59 referrals by private physicians. For 3 years, internists and psychiatrists have worked closely together sharing in decision-making and aiming at total care. We think that the patients benefit from the fact that the psychiatrist is fully integrated in the therapeutic team and does not function only as a consultant in psychiatry. His intervention is more natural and he is accepted easily by the patients. We hardly ever encounter the well-known misgivings of the aged toward psychiatry. The psychiatrist has an important preventive role in the early discovery of psychiatric illness. All too often the patient, his family and even the treating physician have a tendency to focus on the physical symptoms. The patient does not merely need a diagnosis, but above all, an emphatic attitude on the part of all toward his psychosocial or psychiatric problems, the latter frequently underrated in favour of the somatic manifestations, a priority considered more important.