Amy was an eighty-year-old admitted to “new” Pine ward with depression. Following internal reorganisation, Pine had been designated as an acute mixed geriatric admission ward for the Thanet district. In the same block Poplar and Elm had also been designated as similar wards for the elderly from the Canterbury and Dover/Folkestone districts. Pine ward, on the ground floor, had been extensively renovated to accommodate older persons of both sexes, with separate dormitories rather than the one hangar-like that was the standard for most of the larger wards. As it had been opened shortly after the reorganisation the available beds were allocated mostly to self-caring patients from the long-stay wards as an interim strategy until an influx of acute older patients materialised. So the majority of the patients on the ward had enduring mental health problems with associated behaviours, and, although deemed self-caring, many were quite dependent, institutionalised and often quite isolated.
On admission Amy was clearly low in mood, fairly unresponsive with poor appetite and little energy or inclination to care for herself. She had to be encouraged to get out of bed and cajouled into getting dressed and monitored at mealtimes to ensure she had a minimal diet. She was considered for ECT, but, because of her age, it was decided that she would benefit from a course of anti-depressants.
After several weeks there was a marked improvement in Amy’s mood. She began to take pride in looking after herself and began responding to both staff and patients on the ward. She began to help out in the ward kitchen, taking over washing-up duties, laying the tables for meals and running errands about the hospital. Her improvement in mood was not always steady or straight forward. There were odd moments, often in the evening when she was sat on her bed, when she would become tearful. On another occasion she wept when someone on the ward (whom she barely knew) passed away. But commonly she presented a cheerful face and was especially solicitous of the younger female nurses on the ward whom she might help with bed-making or similar tasks.
Amy lived alone in her own detached home in Ramsgate. Her husband had died about a year before she was admitted and she had no immediate family nearby (her daughter lived in Newcastle and her son had emigrated to Australia). She had little contact with her neighbours and reported that most of her friends had died. Fundamentally she had become isolated and lonely which had gradually impacted on her mood. She said that she had nothing much to live for, although (she said) she had not contemplated ending her own life.
Three months into her admission she had become a key figure on the ward, spending time with many of the previously unresponsive long-stay patients. She accompanied some to bingo or the social club and assisted some of the less able to dress. She helped a couple of women with their personal needs, taking them to the hairdressers or assisting with make-up. She seemed to have a kind word for everyone and certainly gave support to some of the newly-admitted women when they were particularly distressed or anxious. Amy said that she felt needed and enjoyed the attention she received from others.
Eventually the time came when it was felt that Amy had recovered and the decision to discharge her home was made. This made Amy very anxious and as discharge became imminent, she became tearful, but the medics were adamant that she should return home with a reduced dose of medication as she was “cured”.
Three weeks later Amy was readmitted in exactly the same state as her previous admission. She was depressed, apathetic and tearful. She had been referred back by letter to her GP but neither had made contact with the other. No other follow-up support had been offered or provided. It was back to square one. Amy’s improvement during her first admission was attributed to the medication she had been prescribed. Yet is was clear that the same medication had been ineffectual following her discharge. All had failed to identify loneliness at the core of her deterioration in mood which had been alleviated by the many social contacts she had enjoyed as an in-patient.
I was no longer on the ward when Amy was discharged, but I was informed that the second admission took a similar course to the first and that Amy had become quite well and discharged home care of her GP.
6 April 2025
