The geriatric program at QBH will address the patient who is age 65 or older and has a psychiatric disorder complicated by a co-morbid medical illness or age related loss of function. The program will address these patients with two branches of expertise: biological and psycho-social.
The biological branch will consist of an evaluation by a geriatric psychiatrist whose examination will consist of:
- An interview with the patient in which a complete history of illness is taken and a mental status examination is done with emphasis on cognitive function.
- A collection of collateral information from family members and medical records.
- An ongoing interaction with all providers by means of an exchange of e-mail addresses, fax numbers, and especially “black line” phone numbers or cell phone numbers.
- Genomic testing. Since patients over 65 are usually on 5 or more medications from 3 or more providers, it will be necessary to assess the genetic composition of enzymes. This will insure the avoidance of dangerous interactions.
The psycho-social branch will consist of the efforts of a member of the geriatric team called a “coordinator”. This will be a nursing and or social service professional that will interact with care givers which will include family members, visiting nurse association and the department of elderly affairs. The coordinator will address typical geriatric problems such as:
- The need for a system of drug dispensing. The patient may need help in setting up a schedule of dosing. There will also be a need for the patientto be aware of the medication taken , the dose and time it is taken., Often the patient’s awareness is limited to what they call “the little white pill”.
- The need to assess driving skills. The geriatric population is notorious for their reluctance to give up the need to drive. A monitoring device may be needed that is attached to dash board and records all driving habits of the operator.
- The need to asses the patient’s ability for activities of daily living. Grocery shopping, meal preparation, and self care may need to be addressed.
- Counseling of patient and family members may be needed to be addressed the dreaded but inevitable question of when independent living is no longer possible.
- The “care giver” will be interviewed to assess the high probability of “reactive illness”. A recent study has shown that almost 100% of care givers are depressed when the patient is depressed. (Donald et. al. Int. J Geriat Psych 1988: 13:248-256)
QBH will abide by and follow the policies and recommendations of the National Association of Professional Geriatric Care Managers published in their “Standards of Practice” guidelines.
“Do You Really Need Less Sleep As You Age?” – Time Health