- Email: [email protected]
Home-Delivered Problem Solving Interventions: Getting off the Couch
2015 AAGP Annual Meeting 1 2
University of California, San Francisco, San Francisco, CA Duke University, Durham, NC
Abstract: As survival rates after late-life acute medical and surgical events increase, clinicians are starting to appreciate that acute and long-term cognitive and neuropsychiatric sequelae of these events extend well beyond the recovery period to negatively affect quality of life. In addition, the late-life medical and surgical events are associated with neurological changes that may increase the risk for subsequent disease onset with even more significant functional effects (e.g., Alzheimer’s disease). This presentation panel will discuss how common risk factors (particularly frailty) can affect long-term cognitive and functional effects after acute medical and surgical events. Focus is then given to discussion of delirium and postoperative cognitive decline as examples of significant acute and long-term neuropsychiatric sequelae from acute medical and surgical events. Delirium, which is common in patients hospitalized for medical and surgical events, has been traditionally viewed as an acute neuropsychiatric disorder, but recent data suggest that delirium may be better conceptualized as a chronic neuropsychiatric disorder, with potentially preventable risk factors and subsequent cognitive impairment. Postoperative cognitive decline (POCD) may affect up to 40% of older post-operative patients and can persist well beyond acute stabilization and recovery. Neuropsychological and neuroimaging research has revealed common cognitive patterns associated with POCD, as well as changes in cerebral structure and function , which provide insights into the risk factors for and mechanisms of delirium and long-term functional outcomes. Faculty Disclosures: Jeffrey N. Browndyke Nothing to disclose Barbara Kamholz Nothing to disclose Sophia Wang Nothing to disclose
HOME-DELIVERED PROBLEM SOLVING INTERVENTIONS: GETTING OFF THE COUCH Session 103 Kimberly A. Van Orden1; Dimitris Kiosses, PhD2; Grace Niu3; Namkee G. Choi4 1
University of Rochester School of Medicine, Rochester, NY Weill Cornell Medical College, White Plains, NY 3 University of California, San Francisco, San Francisco, CA 4 University of Texas at Austin, Austin, TX 2
Abstract: Older adults with depression are not likely to present for care in mental health clinics, necessitating the use of alternate treatment models. Problem solving therapy (PST) is an effective component of treatment for late life depression in primary care that has been adapted for delivery in the home by nurses and social workers. Its portability to the home addresses challenges such as transportation difficulties and functional impairment; however, challenges remain. We will address several challenges for home based PST: integrating the delivery of care in the home by non-medical practitioners with the patients’ health and social service providers; training non-mental health professionals in PST; and delivering the intervention via the telephone. Dr. Van Orden will present an implementation of the Program to Encourage Active, Rewarding Lives for Seniors by an aging services agency in collaboration with a Department of Psychiatry. Dr. Kiosses will present a new home-delivered intervention, Problem Adaptation Therapy for Suicide Ideation (PATH-SI), that targets suicide ideation in middle-aged and older adults with depression, executive dysfunction, and suicide ideation. Dr. Niu will present on the Community Academic Reach of Elders with Depression project, which focused on finding an effective treatment for depressed, disabled, low-income, homebound, older adults through the use of case management and Problem Solving Treatment. Dr. Choi will present on an implementation of home-based, teledelivered PST for low-income homebound older adults, focusing on academic-community partnership building, care coordination between aging-service case managers and licensed master’s-level social workers who delivered PST, and the case managers’ process evaluation. Faculty Disclosures: Namkee G. Choi Nothing to disclose
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Am J Geriatr Psychiatry 23:3, Supplement 1
2015 AAGP Annual Meeting Dimitris Kiosses Nothing to disclose Grace Niu Nothing to disclose Kimberly A. Van Orden Nothing to disclose
PAYING IT FORWARD: DEVELOPING MENTOR-MENTEE RELATIONSHIPS TO ADVANCE GERIATRIC MENTAL HEALTH Session 104 Laura B. Dunn1; Stefana Borovska Morgan1; Daniel D. Sewell2; Ipsit Vahia2 1 2
University of California, San Francisco, San Francisco, CA University of California, San Diego, San Diego, CA
Abstract: Expanding and broadening the bench of geriatric mental health professionals depends in large part on excellent mentoring. Introducing trainees early in their careers to geriatric experiences and mentorship by professionals engaged in geriatric mental health clinical, educational, and research activities is crucial. This session will provide an in-depth discussion of mentor-mentee relationships from multiple perspectives. The literature on mentoring will be summarized, with a particular focus on findings from the field of geriatric mental health. Experienced mentors will discuss their formative experiences as mentees, how these relationships shaped their own careers and approaches to mentoring, and how specific attitudes and behaviors enhance mentor-mentee relationships. Mentees, who are also themselves mentors, will describe their experiences as mentees, what they view as important characteristics of mentor-mentee relationships, and will provide practical advice and resources for trainees at all levels regarding how to find and nurture their mentoring relationships. Faculty Disclosures: Stefana Borovska Morgan Nothing to disclose Laura B. Dunn Nothing to disclose Daniel D. Sewell Nothing to disclose Ipsit Vahia Nothing to disclose
TESTAMENTARY CAPACITY: A MOCK TRIAL Session 105
Benjamin Liptzin1,2; Jay Luxenburg5; Ken Shulman4; Elliott M. Stein3 1
Baystate Medical Center, Springfield, MA Tufts University School of Medicine, Boston, MA 3 Jewish Home of San Francisco, San Francisco, CA 4 Sunnybrook Medical Center, Toronto, ON, Canada 5 On Lok Lifeways, San Francisco, CA 2
Am J Geriatr Psychiatry 23:3, Supplement 1
S7
University of California, San Francisco, San Francisco, CA Duke University, Durham, NC
Abstract: As survival rates after late-life acute medical and surgical events increase, clinicians are starting to appreciate that acute and long-term cognitive and neuropsychiatric sequelae of these events extend well beyond the recovery period to negatively affect quality of life. In addition, the late-life medical and surgical events are associated with neurological changes that may increase the risk for subsequent disease onset with even more significant functional effects (e.g., Alzheimer’s disease). This presentation panel will discuss how common risk factors (particularly frailty) can affect long-term cognitive and functional effects after acute medical and surgical events. Focus is then given to discussion of delirium and postoperative cognitive decline as examples of significant acute and long-term neuropsychiatric sequelae from acute medical and surgical events. Delirium, which is common in patients hospitalized for medical and surgical events, has been traditionally viewed as an acute neuropsychiatric disorder, but recent data suggest that delirium may be better conceptualized as a chronic neuropsychiatric disorder, with potentially preventable risk factors and subsequent cognitive impairment. Postoperative cognitive decline (POCD) may affect up to 40% of older post-operative patients and can persist well beyond acute stabilization and recovery. Neuropsychological and neuroimaging research has revealed common cognitive patterns associated with POCD, as well as changes in cerebral structure and function , which provide insights into the risk factors for and mechanisms of delirium and long-term functional outcomes. Faculty Disclosures: Jeffrey N. Browndyke Nothing to disclose Barbara Kamholz Nothing to disclose Sophia Wang Nothing to disclose
HOME-DELIVERED PROBLEM SOLVING INTERVENTIONS: GETTING OFF THE COUCH Session 103 Kimberly A. Van Orden1; Dimitris Kiosses, PhD2; Grace Niu3; Namkee G. Choi4 1
University of Rochester School of Medicine, Rochester, NY Weill Cornell Medical College, White Plains, NY 3 University of California, San Francisco, San Francisco, CA 4 University of Texas at Austin, Austin, TX 2
Abstract: Older adults with depression are not likely to present for care in mental health clinics, necessitating the use of alternate treatment models. Problem solving therapy (PST) is an effective component of treatment for late life depression in primary care that has been adapted for delivery in the home by nurses and social workers. Its portability to the home addresses challenges such as transportation difficulties and functional impairment; however, challenges remain. We will address several challenges for home based PST: integrating the delivery of care in the home by non-medical practitioners with the patients’ health and social service providers; training non-mental health professionals in PST; and delivering the intervention via the telephone. Dr. Van Orden will present an implementation of the Program to Encourage Active, Rewarding Lives for Seniors by an aging services agency in collaboration with a Department of Psychiatry. Dr. Kiosses will present a new home-delivered intervention, Problem Adaptation Therapy for Suicide Ideation (PATH-SI), that targets suicide ideation in middle-aged and older adults with depression, executive dysfunction, and suicide ideation. Dr. Niu will present on the Community Academic Reach of Elders with Depression project, which focused on finding an effective treatment for depressed, disabled, low-income, homebound, older adults through the use of case management and Problem Solving Treatment. Dr. Choi will present on an implementation of home-based, teledelivered PST for low-income homebound older adults, focusing on academic-community partnership building, care coordination between aging-service case managers and licensed master’s-level social workers who delivered PST, and the case managers’ process evaluation. Faculty Disclosures: Namkee G. Choi Nothing to disclose
S6
Am J Geriatr Psychiatry 23:3, Supplement 1
2015 AAGP Annual Meeting Dimitris Kiosses Nothing to disclose Grace Niu Nothing to disclose Kimberly A. Van Orden Nothing to disclose
PAYING IT FORWARD: DEVELOPING MENTOR-MENTEE RELATIONSHIPS TO ADVANCE GERIATRIC MENTAL HEALTH Session 104 Laura B. Dunn1; Stefana Borovska Morgan1; Daniel D. Sewell2; Ipsit Vahia2 1 2
University of California, San Francisco, San Francisco, CA University of California, San Diego, San Diego, CA
Abstract: Expanding and broadening the bench of geriatric mental health professionals depends in large part on excellent mentoring. Introducing trainees early in their careers to geriatric experiences and mentorship by professionals engaged in geriatric mental health clinical, educational, and research activities is crucial. This session will provide an in-depth discussion of mentor-mentee relationships from multiple perspectives. The literature on mentoring will be summarized, with a particular focus on findings from the field of geriatric mental health. Experienced mentors will discuss their formative experiences as mentees, how these relationships shaped their own careers and approaches to mentoring, and how specific attitudes and behaviors enhance mentor-mentee relationships. Mentees, who are also themselves mentors, will describe their experiences as mentees, what they view as important characteristics of mentor-mentee relationships, and will provide practical advice and resources for trainees at all levels regarding how to find and nurture their mentoring relationships. Faculty Disclosures: Stefana Borovska Morgan Nothing to disclose Laura B. Dunn Nothing to disclose Daniel D. Sewell Nothing to disclose Ipsit Vahia Nothing to disclose
TESTAMENTARY CAPACITY: A MOCK TRIAL Session 105
Benjamin Liptzin1,2; Jay Luxenburg5; Ken Shulman4; Elliott M. Stein3 1
Baystate Medical Center, Springfield, MA Tufts University School of Medicine, Boston, MA 3 Jewish Home of San Francisco, San Francisco, CA 4 Sunnybrook Medical Center, Toronto, ON, Canada 5 On Lok Lifeways, San Francisco, CA 2
Am J Geriatr Psychiatry 23:3, Supplement 1
S7