Specialized geriatric treatment on the rise

Americans are getting older. As the baby-boomers, those born between 1946 and1964, have hit retirement age and as Americans live longer, the population of the United States has seen an increase in people over age 65

A result of this large sector of the population aging has been the attention senior issues have generated. From increased funding for Alzheimer’s and dementia research to greater options in financial planning, housing and nursing care, this generation has brought greater focus to concerns that were once relegated to the backburner partially because of a lack of funding for what was historically a poorer, less vocal part  of the population.

The population shift has seen repercussions within mental health care – with the demand growing. Greater attention has been placed on geriatric psychiatry by medical centers aiming to develop programs designed specifically for the aged.

Administrators and providers recognize that this population requires programming geared towards its specific needs. Not only are the issues seniors face more complex but the problems that they had already been dealing with continue to plague them as they age.

“These issues do not disappear in people just because they turn 65,” said Scott Haltzman, M.D., medical director of the department of behavioral health at Fatima Hospital in Providence, Rhode Island.

While American hospitals have long offered geriatric medical care as a specialty, the growth in mental health care targeted specifically at this group has been more recent. Hospital services now often include both in- and outpatient units with short-term, intensive psychiatric treatment programs, group and individual therapy, family support, psychological testing, dementia assessments and more.

In Rhode Island, CharterCARE Health Partners’ two hospitals, Fatima Hospital and Roger Williams Medical Center, which have the state’s first senior-friendly emergency departments, provide geriatric psychiatric care with 12- and 21-bed secure inpatient units.

At the Maine Medical Center, an interdisciplinary team provides standard psychiatric evaluations, neuropsychological assessments and cognitive-behavioral services (among others), for a state population known as the “oldest” in the country.

In Connecticut, UConn Health provides inpatient care as well and has taken a further step towards integration by housing its geriatric psychiatric clinic within the geriatric medical unit.

“This is something we developed in the last few years,” said David Steffens, M.D., professor and chairman in the department of psychiatry for University of Connecticut School of Medicine. “It is a model many places around the country are adopting and we are the first in this part of Connecticut.”

“Certainly this is a long overdue need,” Steffens added. “When I came here three years ago, the health center didn’t have a geriatric psychiatrist. Part of my goal has been to expand these programs.”

For baby boomers, who have grown accustomed to having the American culture fluctuate with and around them, a demand for high-end geriatric care has forced providers to step up and meet their needs.

“Psychiatric needs of the geriatric population differ from the general population,” said Haltzman. “For instance, in a non-geriatric unit we might spend more time talking in group about a job search or about relationship issues. With this group, we might be talking instead about end of life issues or depression and dementia.”

Geriatric units are also equipped differently and employ extra staff to assist those who may have trouble moving about.

“Seniors are unique medically and complex psychologically at this stage in life,” said John Campbell, M.D., medical director of general hospital psychological services for Maine Medical Center. “There is often sensory or visual impairment and we need to develop patient-centered ways to deal with their unique needs.”

In a geriatric unit, the staff, Campbell added, can deal with more of the “subtleties” of reading the needs of the clientele that he feels would be lost in a general psychiatric care unit.

Providing care within a hospital setting has its benefits, of course, for all age groups. For a sector that may have more co-existing conditions than most, it is almost a must.

“I would say that for patients coming to our unit, they are on an average of six medicines besides the psychiatric meds,” said Haltzman. “Part of the reason they often end up requiring psychiatric care is because they have an underlying medical problem that needs to be addressed.”

For the industry, the aged present specific challenges, beyond what concerns face the individual. Geriatric caregivers must learn to work with extended families that often make decisions for the patient and keep the families educated as to end-of-life choices and outpatient care.

And then there are always questions of proper reimbursement for services because many of this age group would be using Medicare for coverage.

“There are challenges with reimbursement rates in dealing with Medicare,” said Campbell. “But rates are what they are and you have got to live with them.”

UConn Health has taken steps to meet the growing demand for care in Connecticut.

“We are in the process of bringing onboard another geriatric psychiatrist,” said Steffens. “It definitely will help meet a need here. We have also been able to branch out to local assisted living facilities and we are very excited about the support we have gotten to expand services.”

Working in geriatric psychiatry has its own rewards. For Haltzman, working with seniors helps him to get a better perspective on his own life. The field will only grow, says Steffens, with greater need for a variety of mental health professionals including psychologists.

“There is a need for geriatric psychologists,” said Steffens. “In fact, there are a lot of studies and evidence showing that specific types of psychotherapy can be very good with improving the depression and anxiety that older adults face.”

An increase in alternative options for serving hard-to-reach seniors is expected. One example is a new tele-psychiatry program Maine Medical Center will introduce to provide care for the state’s rural populations.

“We are not going to get geriatric psychiatry expertise distributed equally across a state as large as Maine,” said Campbell. “This (option) will provide geriatric psychiatry around a state where two-thirds of the population lives in rural, remote areas.”