Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic.
------------------------
Source: Wake Forest University Baptist Medical Center Released: Fri
25-Feb-2005, 11:00 ET
http://www.newswise.com/articles/view/510086/?sc=dwhp
Program to Take Psychiatric Services to Frail Elderly in Their Homes
A groundbreaking outreach program for frail elderly who need psychiatric
services in their homes – believed to be the first of its kind in the
United States – is being launched by Wake Forest University Baptist
Medical Center.
Newswise — A groundbreaking outreach program for frail elderly who need
psychiatric services in their homes – believed to be the first of its
kind in the United States – is being launched by the Department of
Psychiatry and Behavioral Medicine at Wake Forest University Baptist
Medical Center.
“The highest prevalence of mental illness is in those aged 65 and older,
but people in this age group are poor users of mental health services,”
said Deirdre M. Johnston, M.D., the psychiatrist who is medical director
of the new program.
The biggest problem may be an inability to leave the house to get care,
she said, either because of physical illness or disability or because of
the psychiatric illness itself. So instead, members of the new team will
visit homebound patients at home.
The new program, modeled after successful programs in the United Kingdom
and Canada, is being funded by an endowment established by Arnold H.
Snider of Princeton, N.J., and his wife, Katherine M. Snider. Snider
grew up in Salisbury, where his mother, Kate Mills Snider, still resides.
The Sniders established the Kate Mills Snider Geriatric Psychiatry
Outreach Program – GO for short -- both to honor Snider’s mother, who
received care from Johnston, and to create a model of patient-centered
mental health care for the elderly.
“The Sniders’ gift will make it possible to provide mental health care
while respecting the autonomy of the older patient, and should serve as
a model of how mental health services could be best delivered in our
country,” said W. Vaughn McCall, M.D., professor and chairman of the
Department of Psychiatry and Behavioral Medicine.
Visiting homebound psychiatric patients in their homes may prevent
hospitalization or premature placement in a nursing home.
Constantine G. Lyketsos, M.D., M.P.H., co-director of the Division of
Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins Hospital in
Baltimore, said there is “an enormous need for such programs.” He cited
the rapidly growing number of seniors, especially those who are over 80
years old.
In that age group, he said, “there is a very high rate of psychiatric
problems, often occurring in people who are otherwise frail or have
other medical problems and who therefore can’t easily make it into a
health care setting to get treatment.”
In addition to “late life psychiatric illness, these patients might have
heart failure, cancer, or bad arthritis, and therefore getting to and
from appointments is difficult. For many it is difficult for them to
spend time sitting waiting in a waiting room,” Lyketsos said.
Johnston said, “The GO Program has been established to develop a model
of care that provides outreach mental health services to frail elderly
in their homes. The GO team will accomplish this by partnering with
local community agencies working with this population.”
She hopes to involve agencies such as Senior Services, community mental
health agencies, the Area Agency on Aging, Hospice, primary care
physicians and the local home health agencies.
Johnston said the effectiveness of the program would be assessed at
regular intervals, using standardized psychological and psychiatric
tests to measure mood, cognition, functional capacity, quality of life,
caregiver burden, and health services utilization.
The Sniders’ gift will provide salary support for the medical director,
a clinical nurse specialist, a clinical social worker, and a project
manager. The team will create treatment plans to prevent crises and
improve the quality of life and mobilize the community agencies.
Johnston said Martha Bruce, Ph.D., M.P.H. of Cornell University studied
539 frail elderly patients who were enrolled in home care programs and
found that 73 of them, or 15 percent, had major depression, a specific
psychiatric diagnosis.
Major depression often leads to additional medical problems, reports of
unexplained pain and inability to perform such tasks as cooking,
managing money and doing household chores, known collectively as
instrumental activities of daily living.
“This group is also at greatest risk of suicide, particularly in the
presence of chronic illness and/or social isolation,” said Johnston.
The number of people 65 and older is expected to double by the year
2030, growing from 969,000 in 2000 to 2.2 million in 2030. At present,
she said, about 45.7 percent of N.C. adults in this age group have a
disability.
Alzheimer’s disease is one disability that will affect increasing
numbers of people as baby boomers age. Currently, there are 4.5 million
cases in America and the numbers is expected to increase to at least
11.3 million cases by 2050.
“Alzheimer's is frequently associated with a range of behavioral
symptoms,” Johnston said. “These behavioral symptoms are the main reason
for hospitalization or institutionalization of Alzheimer’s disease
sufferers. Caregivers also are at increased risk for depression so
caregivers may benefit from the GO program directly, through recognition
of stress and treatment of associated depression.”
About Wake Forest University Baptist Medical Center: Wake Forest Baptist
is an academic health system comprised of North Carolina Baptist
Hospital and Wake Forest University Health Sciences, which operates the
university’s School of Medicine. The system comprises 1,298 acute care,
psychiatric, rehabilitation and long-term care beds and is consistently
ranked as one of “America’s Best Hospitals” by U.S. News & World Report.
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