Hoofdstuk in Progression in forensic Psychiatry: About Boundaries van prof. mr. Marc Groenhuijsen en prof. dr. T.I. Oei. As a young adolescent the man started using soft drugs and as a result was expelled from school. Following a registration with RIAGG he was placed in a children’s home for some years. From the age of twenty he was a frequent substance user. He got hold of these substances because his father was a dealer. There were contacts with psychiatrists and psychologists and he was on an anti-psychotic medication that is prescribed with schizophrenia. Over a period of eight years he was admitted eight times to a psychiatric hospital with diagnoses such as recurring paranoid schizophrenia, recurring poly-hard drugs use and ADHD. During his hospitalizations he took no medication, did not satisfactorily comply with agreements and frequently withdrew from treatment prematurely in spite of advice to the contrary. He was ultimately given Tbs (1). In the introduction of a theme issue on Mental Health Care and Justice of Justitiële Verkenningen [Judicial explorations] from 1991 concerning such a track record it was stated that many stories can be told about it. “Two of them have farreaching consequences. From the point of view of the judiciary the track record is evaluated as to the degree of guilt casu quo attribution and the need to make society secure. From the point of view of mental health care a person with a mental disorder committed an offence as a result of his condition and needs help” (2) Dangerous or mad, that is the division that is sectorially made.
BACKGROUND: Regaining walking ability is a key target in geriatric rehabilitation. This study evaluated the prevalence of walking ability at (pre-)admission and related clinical characteristics in a cohort of geriatric rehabilitation inpatients; in inpatients without walking ability, feasibility and effectiveness of progressive resistance exercise training (PRT) were assessed.METHODS: Inpatients within RESORT, an observational, longitudinal cohort of geriatric rehabilitation inpatients, were stratified in those with and without ability to walk independently (defined by Functional Ambulation Classification (FAC) score ≤ 2) at admission; further subdivision was performed by pre-admission walking ability. Clinical characteristics at admission, length of stay, and changes in physical and functional performance throughout admission were compared depending on (pre-)admission walking ability. Feasibility (relative number of PRT sessions given and dropout rate) and effectiveness [change in Short Physical Performance Battery, FAC, independence in (instrumental) activities of daily living (ADL/IADL)] of PRT (n = 11) in a subset of inpatients without ability to walk independently at admission (able to walk pre-admission) were investigated compared with usual care (n = 11) (LIFT-UP study).RESULTS: Out of 710 inpatients (median age 83.5 years; 58.0% female), 52.2% were not able to walk independently at admission, and 7.6% were not able to walk pre-admission. Inpatients who were not able to walk independently at admission, had a longer length of stay, higher prevalence of cognitive impairment and frailty and malnutrition risk scores, and a lower improvement in independence in (I)ADL compared with inpatients who were able to walk at both admission and pre-admission. In LIFT-UP, the relative median number of PRT sessions given compared with the protocol (twice per weekday) was 11 out of 44. There were no dropouts. PRT improved FAC (P = 0.028) and ADL (P = 0.034) compared with usual care.CONCLUSIONS: High prevalence of inpatients who are not able to walk independently and its negative impact on independence in (I)ADL during geriatric rehabilitation highlights the importance of tailored interventions such as PRT, which resulted in improvement in FAC and ADL.
Backgroundthe efficacy and outcomes of geriatric rehabilitation (GR) have previously been investigated. However, a systematic synthesis of the aspects that are important to patients regarding the quality of GR does not exist.Objectivethe aim of this scoping review was to systematically synthesise the patients’ perspective on the quality of GR.Methodswe followed the Scoping Review framework and gathered literature including a qualitative study design from multiple databases. The inclusion criteria were: a qualitative study design; a geriatric population; that patients had participated in a geriatric rehabilitation programme and that geriatric rehabilitation was assessed by the patient. The results sections of the included studies were analysed using a thematic analysis approach.Resultstwenty articles were included in this review. The main themes identified were: (i) the need for information about the rehabilitation process, (ii) the need for telling one’s story, (iii) the need for support (physical, psychological, social and how to cope with limitations), (iv) the need for shared decision-making and autonomy, (v) the need for a stimulating rehabilitation environment and (vi) the need for rehabilitation at home.Conclusionin this study, we identified the aspects that determine the quality of rehabilitation from the patient’s perspective, which may lead to a more holistic perspective on the quality of GR.
MULTIFILE
