PSYCHIATRIC EVALUATION OF GERIATRIC PATIENTS ON AN OUTPATIENT BASIS: PRELIMINARY STUDY

The number of patients admitted to State hospitals with the diagnosis of chronic brain syndrome associated with senility or cerebral arteriosclerosis is steadily increasing and approaches the number of patients admitted with the diagnosis of schizophrenia (1). During the years 1955 and 1956 more than 33 per cent of all patients admitted to the Osawatomie State Hospital in Kansas were over 65 years of age, and more than 40 per cent were over the age of 60. A great number of these patients were retained after the 90-day observation period. At the present time about 45 per cent of all the patients at the hospital belong to the geriatric group. According to Kolb (2), the number of persons over 65 in the United States increased 57.5 per cent from 1936 to 1957, and the number of first admissions of persons 65 and over to state mental hospitals increased 95.5 per cent. Using statistical materials, Bettag and his associates (3) predict that in the year 2000, 67 per cent of the patients in State hospitals and 13.2 per cent of the national population will be over 65. Whereas in the past, a feeling of helplessness and lack of interest in this problem has been a characteristic feature of most psychiatrists, in recent years, due to the publications of Gitelson (4), Goldfarb (5), Meerloo (6), Busse et al. (7), Linden (8) and others, a better understanding of the emotional problems and needs of geriatric patients has taken the place of the apathetic, nihilistic "custodial care" attitude. Furthermore, thanks to the efforts of Cosin (Oxford, England) (9) and of Cameron (Montreal, Canada) (10), geriatric units have been created which emphasize Day-Center treatment and an active Rehabilitation Service, and attach great importance to social relationships of geriatric patients in regard to their readjustment in their own family and community. An active treatment program in the hospital alone is not sufficient to help the situation. Placement of geriatric patients ready to leave the hospital is a complicated procedure. Very often the return to their families does not bring the desired results, because the stress situation (which caused the patient's hospitalization) remains unchanged. Moreover, placing them in foster homes or nursing homes, frequently does not solve this difficult problem. Therefore, at Osawatomie State Hospital a method was tried, with the aim of keeping many geriatric patients from being admitted to the hospital after referral by Court order for a 90-day observation period. The applications for all patients aged 60 and older (with a few emergency exceptions) were carefully considered. Before any decision regarding hospitalization was made, each pa-