2014 AAGP Annual Meeting

Shilpa SrinivasanNothing to disclose

IMPLEMENTATION OF INTEGRATED COLLABORATIVE GERIATRIC MENTAL HEALTHCARE MODELS: WHAT HAVE WE LEARNED FROM A DECADE OF EXPERIENCE?Session 204Joel E. Streim1,2; Malaz Boustani3; Jurgen Unutzer4; David W. Oslin2,1

1University of Pennsylvania, Philadelphia, PA2Philadelphia VA Medical Center, Philadelphia, PA3Indiana Univeristy School of Medicine, Indianapolis, IN4University of Washington School of Medicine, Seattle, WA

Abstract: Geriatric mental health services research has provided a strong foundation of evidence for the effectiveness of collab-orative care models for integrating mental health care within primary care systems. Research findings include the achievement ofbetter case identification, patient access and engagement, treatment adherence, clinical and functional outcomes, quality of care,and patient satisfaction. Based on this evidence, several of these models have been disseminated, with various collaborative careprograms implemented over past decade in the context of the health care reform movement in the U.S. This symposium willexamine the implementation experience of a few select programs, focusing on (1) elements and strategies that led to successfulimplementation, (2) challenges to implementation and approaches to managing barriers, and (3) the continual process of mea-surement, learning, adaptation and program improvement. Dr. Streim, as session chair, will introduce the symposium andsummarize the background and objectives. In the first of three presentations, Dr. Malaz Boustani will describe implementation ofdementia care models and discuss relevant principles of implementation science. The second presentation, by Dr. Jurgen Unutzer,will review the extensive implementation experience with IMPACT across a range of settings where older adults receive theirgeneral medical care. For the third presentation, Dr. David Oslin will examine the dissemination of the BHL model, withimplementation experience in federal, state, and private sector health systems. Dr. Streim will summarize the lessons from over adecade of implementation experience, and will moderate the final segment of this symposium, during which members of theaudience will be invited to participate in an “open-mike” exchange with the panel of presenters, sharing their experiences andapproaches to implementation and participation in programs of collaborative care.

Faculty Disclosures:Malaz BoustaniNothing to disclose

David W. OslinNothing to disclose

Joel E. StreimNothing to disclose

Jurgen UnutzerNothing to disclose

INNOVATIVE MODELS OF GERIATRIC MENTAL HEALTH SERVICES INLONG-TERM CARESession 313Allan A. Anderson1; Leo Borrell3; Junji Takeshita2

1Johns Hopkins School of Medicine, Easton, MD2University of Hawaii, Honolulu, HI3Senior PsychCare, Houston, TX

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2014 AAGP Annual Meeting

Abstract: The Long-Term Care (LTC) environment is increasingly housing residents with significant mental health concerns.This includes older psychiatric patients who may be diagnosed with a major psychiatric disorder as well as patients admittedto nursing facilities (NF) for sub-acute care who suffer from delirium or an adjustment disorder following their admissionfrom an acute care hospital. A majority of current LTC residents carry a diagnosis of Alzheimer’s disease or other dementia.A high percentage of such residents will at some time exhibit neuropsychiatric symptoms that may require acuteintervention.On average, NF and ALF direct care staff have very limited skills in regards to their knowledge of psychiatric illness and oftenlack skills in intervening with residents who present with behavioral disturbance related to their diagnosis of dementia. Sit-uations arise where symptoms of mental illness and behaviors of dementia either go unrecognized or when recognized, areoften untreated or undertreated. Lack of appropriate interventions may then lead to many negative outcomes including un-necessary psychiatric or medical hospitalizations, inappropriate use of psychiatric medications, staff and resident injuries, andother unintended consequences.The active presence of geriatric psychiatrists and other geriatric mental health clinicians can help to improve these problems.However, there are few incentives for geriatric mental health clinicians to enter such sites of service. During this session severalclinical and financial models of LTC geriatric mental health programs will be presented. There will be adequate time devoted tothe practical issues of providing such a service.

Faculty Disclosures:Allan A. AndersonNothing to disclose

Leo BorrellNothing to disclose

Junji TakeshitaNothing to disclose

INNOVATIVE RESEARCH ON SUICIDE IN OLDER ADULTSSession 104Dimitris N. Kiosses1,3; Katalin Szanto2; Yeates Conwell4; George S. Alexopoulos1,3

1Weill Cornell Medical College, White Plains, NY2University of Pittsburgh Medical Center, Pittsburgh, PA3Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY4University of Rochester Medical Center, Rochester, NY

Abstract: Suicide is a devastating event for the individuals, their families and the community. Understanding the risks ofsuicide behavior in older adults and exploring different interventions to reduce suicide ideation is an important clinical andresearch issue. This symposium will focus on correlates of baseline suicide ideation, explore a newly developed stress/diathesismodel of suicidal behavior in late-life, and describe a randomized trial of peer companionship and its effect on depression,suicide ideation and psychological and structural connectedness.Dr. Dimitris Kiosses will discuss the incidence of suicide ideation and its correlates in 81 older adults with major depressionand cognitive impairment. Specifically, Dr. Kiosses will examine the effects of clinical (depression symptoms and depressionseverity) and neuropsychological variables (overall cognitive impairment, memory deficits, and executive dysfunction) aswell as measures of social support on suicide ideation in older adults with cognitive deficits, up to the level of moderatedementia. He will also discuss the different profiles of older adults with suicide ideation with varying degrees of cognitiveimpairment.Dr. Katalin Szanto will discuss a newly developed stress/diathesis model of suicidal behavior in late-life that may help toidentify modifiable risk factors. Suicide follows an altered decision process. There is accumulating evidence that the suicidaldiathesis involves cognitive deficits and maladaptive decision-making. The discussion of the model will be based on evidencefrom the literature, as well as from recent cognitive and behavioral data from over 100 depressed elderly who attempted suicideand demographically similar controls groups. The behavioral data provide new insight into facets of impulsivity, prominent insuicide attempters, and link these to objective characteristics of suicide attempt (planning and medical lethality).

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