Lessons Learned in Geriatric Collaborative Care: What if the Status Quo Just Won ’ t Budge?

1. Session #A5c Saturday, October 12, 2013 Lessons Learned in Geriatric Collaborative Care: What if the Status Quo Just Won’t Budge? Katherine Buck, MS, LMFT Psychology Intern, University of Colorado SOM, Dept of Family Medicine Doctoral Candidate, Clinical Health Psychology East Carolina University Dennis Russo, PhD, ABPP Clinical Professor of Family Medicine and Psychology, Head Of Behavioral Medicine, Department of Family Medicine, East Carolina University Eric Watson, MS Doctoral Student, Clinical Health Psychology, East Carolina University Collaborative Family Healthcare Association 15th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A.

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Objectives • Describe the importance of collaborative care research regarding mental health (depression) outcomes for older adults in medical settings • Identify challenges to collaborative care research in an inpatient setting with geriatric populations • Discuss solutions to collaborative care research barriers for geriatric, inpatient populations

4. Learning Assessment What percentage of geriatric hospitalizations are due, at least in part, to depression? • 26% • 39% • 47% • 58% Laudisio, et al (2010)

5. Our Team and Our Mission • The Team • Clinical Psychologist, RN Clinical Nurse Manager (inpatient unit), 2 psychology graduate students, RN floor staff, and one undergraduate research assistant • The Mission • Project revolving around inpatient geriatrics and depression • How to choose a focus?

6. What others knew … • 16% of Geriatric Outpatients diagnosed with depression, but this is likely higher inpatient (Reynolds & Kupfer, 1999) • Geriatric patients with depression  Higher rates of illness, higher illness burden, and increased risk of suicide (Levy, 2011) • BUT, we’re not getting all the diagnoses right! (Castel, Shahar, German, & Boehem, 2006; Koenig, H., 2006; Garrard, et al, 1998) • In fact, up to 50% of MDs report diagnostic confusion in geriatric patients.

7. Beginnings of a collaborative project • ECU Dept of Family Medicine • Already do some consulting to inpatient unit • Full range of behavioral health services as outpatient, including work in brand new Geriatrics Center • Initial Planning of integrated research • Team met several times – at first included RN, clinical psych, and 1 graduate student • Grew to include nursing research supervisor for hospital (as consultant) • Graduate student – point person on day to day execution

8. The Study Itself • Planned procedures • RN staff would screen/administer, then Bmed staff would conduct chart reviews • Consent, MINI-Cog, GDS, “Detection” question, Chart review (demographics, treatment team, past depression dx, current treatment for depression, and assessment of depression) • Examine correlations between various demographic/treatment factors and provider/patient detection

9. Study Findings • 36 Participants • GDS above cutoff – 28.6% • Mean age – 73.4 • 17 C, 19 AA; 10 M, 26 F • Zero SI endorsed by any patient or staff • Patient detection correlated with : • Life is empty*** • Bored • Happy*** • Extra High yield questions?

10. Study Findings • GDS NOT correlated with age, gender, hospital admits • GDS WAS correlated with self detection • RN data – not usable • Depression variables (problem list, treatment plan, medication) – indicated some scattered documentation • We are capturing it in at least one place (usually) • Problem list was key variable (link)

11. Lessons Learned • Collaboration – better upfront planning • Better buy in from “on the ground staff” • Needed “point person” for RN (ie, RN student) • Better operational definitions (via chart abstraction) • Unexpected factors • Admission numbers • Flu • Technical difficulties (staffing, space, computer) • Contingency planning

12. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!