Initial adjustment to a long-term care institution: medical and behavioral aspects

One hundred elderly persons consecutively admitted to the Jewish Home and Hospital for Aged were studied during the first month after admission. Medical changes (chiefly cardiovascular) and behavioral changes were analyzed independently and then correlated. Four subgroups were found: 1) smooth adjustment and no significant medical changes (33 subjects); 2) smooth adjustment with significant medical changes (17 subjects); 3) severe adjustment problems but no significant medical changes (31 subjects); and 4) severe adjustment problems with significant medical changes (19 subjects). The aged persons most likely to have initial adjustment difficulties usually had poor capacity for interpersonal relationships, were socially isolated, were either single or divorced, had a dependent personality, had severe chronic brain syndrome, had a negative or ambivalent attitude toward admission, and often had been referred for psychiatric evaluation before admission. Major patterns of reaction were anxiety, aggressiveness and depression. Significant medical changes were more likely to develop in those with previous poor health who manifested an advanced state of confusion and depressive trends. Depression was related to concomitant medical changes rather than to the previous health status; it exacerbated the reaction to medical illness, which resulted in a decline in the level of functioning. In 58 per cent of the 50 patients with initial adjustment difficulties, a satisfactory level of adaptation was reached during the first six months after admission.