Treatment of Psychosis Among Older Adults in Residential Care Facilities: A Review of Clinical Cases Using Quetiapine

A C L I N I C A L J O U R N A L O F T H E A M E R I C A N G E R I A T R I C S S O C I E T Y he psychiatric needs of older adults in residential care settings are significant. While increasing attention has been given to the mental health needs of elderly nursing home residents, other facilities, including assisted living facilities, board and care homes, and adult foster care programs, present unique treatment challenges for caregivers and physicians. The prevalence of psychiatric illness ranges from 65-90%, with dementia complicated by depression, psychosis, and behavioral disturbances, the most common disorder.1 It is important to note that elderly patients with chronic mental illnesses including schizophrenia, bipolar disorder, major depression, panic disorder, posttraumatic stress disorder, and mental retardation also reside in nursing homes.2 While assisted living facilities and other community residences have a lower prevalence of older adults with dementia, elderly patients who have chronic mental illnesses are often placed in these settings.3 When dementia and other psychiatric disorders are accompanied by psychotic features, including delusions and hallucinations, the patient is more likely to have impaired functional status, display behavioral problems, and require a greater amount of care.4,5 Treatment strategies for psychotic symptoms in the older adult must focus on medications that are efficacious and well-tolerated by this fragile population. The best outcome of medication treatment is the allevia-