Mohammed T. Abou-Saleh

712 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYprovides appropriate consultative care. Because the medicalpsychiatry unit as a treatment modality may increase the riskfor loss of continuity of care or actual loss of follow-up, strategiesfor interim and longitudinal care should be carefully considered.A mechanism should be devised by the medical director forcoordination of all clinical care following discharge. A distinctadvantage of continuity of care after discharge from these units isthe opportunity to assess the impact of psychological andpsychosocial interventions among general medical populations.CONCLUSIONThe geriatric medical psychiatry inpatient unit could continue tobe increasingly important as disproportionate growth occursamong the older population in North America (and Europe). Anintegrative model is essential in the delivery of care, preferably in awell-equipped setting that is organized to concentrate on thecombined care of medical–psychiatric patients. These units arealso quite useful in teaching and research programs, or in settingswhere large consultation–liaison psychiatry programs exist.Leadership provided by the medical director and head nurse,clearly articulated admission criteria and a well-organized multidisciplinaryapproach are all essential ingredients for a successfuloperation. Finally, as economic, social and scientific factorsconverge and shape geriatric psychiatry, the medical inpatient unitmay prove to be an optimal setting for intensive, inpatientgeriatric treatment.REFERENCES1. Young LD, Harsch HH. Inpatient unit for combined physical andpsychiatric disorders. Psychosomatics 1986; 27: 53–60.2. Goldberg RJ, Stoudemire A. The future of consultation–liaison andmedical–psychiatric units in the era of managed care. Gen HospPsychiat 1995; 17: 268–77.3. Stoudemire A, Fogel BS. Organization and development of combinedmedical psychiatry unit: pt 1. In Principles of Medical PsychiatryUnits. New York: Grune & Stratton, 1987; 677–83.4. Folks DG. The role of the consultation liaison psychiatrist on thegeriatric service. In Michels R, Cooper AM, Guze SB et al., eds,Psychiatry. Philadelphia, PA: Lippincott-Raven, 1997.5. Gertler R, Kopec-Schrader Em, Blackwell CJ. Evolution andevaluation of a medical-psychiatric unit. Gen Hosp Psychiat 1995;17: 26–81.6. Kales HC, Blow FC, Dopeland LA et al. Health Care Utilization byolder patients with coexisting dementia and depression. Am JPsychiat 1999; 156: 550–6.7. Fogel BS, Stoudemire A. Organization and development of combinedmedical-psychiatric units: pt II. Psychosomatics 1986; 27: 417–28.8. Unutzer J, Patrick DL, Simon G et al. Depressive symptoms and thecost of health services in HMO patients aged 65 years and older. A 4-year prospective study. J Am Med Assoc 1997; 277(20): 1618–23.9. Mayou R, Hawton K, Feldman E. What happens to medical patientswith psychiatric disorder? J Psychosom Res 1988; 32(4–5): 541–9.10. Goetzel RZ, Anderson DR, Whitmer RW et al. The relationshipbetween modifiable health risks and health care expenditures. J OccupEnviron Med 1998; 40(10): 843–54.11. Goldberg RJ, Kathol R. Implications of the Balanced Budget Act of1997 for general hospital psychiatry inpatient units providing medicaland psychiatric services. Gen Hosp Psychiat 2000; 22: 11–16.12. Liu C-F, Cromwell J. Impact of the Balanced Budget Act of 1997 onPPS-exempt Psychiatric Facilities. Waltham, MA: Health EconomicsResearch Inc., 1998.13. Kathol RG. Integrated medicine and psychiatry treatment programs.Med Psychiat 1998; 1: 10–16.14. National Committee Quality Assurance. 1999 standards, vol 7. 1999,46.15. Mumford E, Schlesinger HJ, Glass GV et al. A new look at evidenceabout reduced cost of medical utilization following mental healthtreatment. Am J Psychiat 1984; 141: 1145–58.