Patient Centered Care in the Acute Setting: A Case Report on the Psychosocial Aspects of Care in a Patient with Agitation, Dementia, and Bipolar Disorder

Background: Neuropsychiatric symptoms, such as agitation and delirium, can be major roadblocks to patient care and have significant negative effects on patient prognosis. With roughly 17% of the geriatric population being hospitalized annually, and 1/3^rd of hospitalized geriatric patients experiencing delirium during their stay, preventing neuropsychiatric disturbances like these and better managing the cases that do occur has become a major focus in the acute care setting. Inherent to the nature of neuropsychiatric conditions, one of the most effective non-pharmaceutical interventions we can alter is our means of interacting with patients. Purpose: The purpose of this case report is to highlight the importance of utilizing patient centered care methods in the management of a patient with vascular dementia demonstrating behavioral challenges in the acute care setting. Description: The patient followed in this case report is a 70-year-old Caucasian male with a substantial medical history, including vascular dementia and type 1 bipolar disorder. Especially significant for this case report was that the patient has a history of institutionalization for psychiatric illnesses, difficulty communicating, and aggressive behaviors with his family during manic and hypomanic episodes. The patient had a complex medical course across his 74-day hospitalization, including a manic episode, intubation, numerous behavioral outbursts, and many medication changes. Intervention: The primary intervention was the utilization of a patient centered care model, with an emphasis on the methods of communication with the patient. Outcome Measures: Primary outcome measures relied on patient participation, patient self-report, and independence in mobility. Ideally, there would have been more objective measures regarding activity tolerance and psychiatric state, but the patient was not consistently an appropriate candidate for these measures. Discussion: The use of patient centered care increased patient compliance, activity, and self-reported mood, while minimizing neuropsychiatric symptoms and other behavioral outbursts.