We wanted to clarify whether patients in psychogeriatric wards were capable of filling in the WAS questionnaire. Five or more patients completed the questionnaires in each ward, a sufficient number to obtain reliable mean values for the wards mainly for patients with psychosis according to Røssberg & Friis (10). Some patients spent a long time filling in the questionnaire and patients with slightly reduced cognition had difficulty understanding the questions. However, with help and a strong emphasis on motivation, many still managed to complete the study.
It is reasonable to believe that the psychogeriatric wards have a higher level of order and organization than the wards mainly for patients with psychosis. Their work is more predictable, as they do not have to accept acute admissions. Emphasis is placed on order in the daily routine with a set rhythm and concrete activities, partly out of consideration for the early cognitive decline in a number of patients.
A lower level of angry and aggressive behaviour also seems plausible. Many older people have a slower pace, less energy and reduced somatic health. As a result, they may appear less threatening or express their anger in a milder form. Furthermore, disagreements with demented patients are more often regarded as confusion and lack of understanding rather than as real conflicts. It is probably noteworthy that aggressive patients are first admitted to the emergency department and only moved when they have become more stable.
Patients in three of the psychogeriatric wards reported a much lower level of staff control, whereas the mixed ward (C) differed little from the wards mainly for patients with psychosis. Ward C had more compulsory admissions which is known to involve more disagreements about rules and control.
Psychotic patients probably consider the staff more often as negative and controlling because they lack understanding of their disease. In other studies the patient score was much higher than the staff score (9, 10) and we find it interesting that this was not the case in the psychogeriatric wards.
A high patient score for support is a less robust, but nevertheless interesting finding. One can imagine that psychotic patients are less able to comprehend the support given them or that older patients are given another type of care, a type that is more easily recognized as support.
The treatment environment is affected by many factors. Friis found that the proportion of psychotic patients and the patients’ mean age were the factors most strongly associated with the patients’ WAS score (12). The background variables most strongly associated with the WAS scores on psychogeriatric wards, however, warrant a separate study with many more participants.
The psychogeriatric patients’ higher score for satisfaction with the staff and the wards in general is striking. Their generation possibly appreciates care more than younger patient groups. Moreover, the patient scores for order and organization, angry and aggressive behaviour, support and staff control deviate from the reference mean (0-line) in directions that correspond well with patient satisfaction according to findings in the reference wards (4, 5, 8). These variables are considered to be among the most important for patient satisfaction on wards for mainly patients with psychosis and can be expected to be important on psychogeriatric wards as well.
Our conclusion is that the WAS questionnaire can be used on psychogeriatric wards with good help from the staff. The psychogeriatric wards had a higher degree of order and organization and patient satisfaction and a lower degree of angry and aggressive behaviour than in wards for mainly patients with psychosis. The low number of participants on each ward should be taken into consideration. This study needs to be followed up by studies of ward atmosphere, satisfaction and work environment in more psychogeriatric wards.