Rapid change in status: the case of William.

In most geropsychiatric inpatient settings, the focus of care is reduction, management, or alleviation of psychiatric signs and symptoms through a combination of behavioral and pharmacologic interventions. However, unidentified or evolving medical conditions among frail older patients may precipitate rapid and unanticipated changes in status. The case of "William" illustrates how prompt adjustments in nursing care, collaboration within and between the geropsychiatric unit and other hospital services, and close working relationships with family may facilitate unexpected end-of-life decisions and promote quality of care.