Geriatric Psychiatry Community Services of Ottawa Services communautaires de géronto-psychiatrie d’Ottawa G P S O C Vickie Demers Clinical Coordinator S G P O

Program Description Community based mental health program Funded by the Ministry of Health and Long-Term Care Bilingual Case management model Client is seen at home by a case manager Interdisciplinary team with geriatric psychiatrists

Program Description Specialized geriatric psychiatry outreach team Individualised assessment and treatment in the client’s home including retirement home Support caregiver/family through education, case management and counseling Collaborate with family physicians and a multitude of community agencies Provide education to professionals, students and community

Goals Improve the care of the elderly in the community optimizing client’s mental health enhancing client’s environment and quality of life linking client to community resources preventing unnecessary hospitalization facilitating necessary hospitalization offering support and education to client, caregivers, and family

Program Staffing Executive Director Medical Director Clinical Coordinator Geriatric Psychiatrists (4) Case managers ( RN, SW & OT ) (16, FTE:12.4) Psychogeriatric Resource Consultant Capacity Assessors Medical Secretaries

Target Population Persons over 65 with mental health problems or suffering from dementia complicated by behavioral or psychological symptoms. Persons less than 65 with Alzheimer’s dementia or frontotemporal dementia complicated by behavioral or psychological symptoms. Persons must live in the Ottawa community (excluding Long Term Care Homes). Persons who reside outside of Ottawa can be seen for a psychiatric consultation. No follow-up with case managers is available. Persons must be referred by a physician (exceptions are made on a case by case basis).

Referral Sources Family physicians and other physicians Memory Disorder Clinic RGAP and other Community Programs and Services Hospitals Champlain Community Care Access Centre (Ottawa) Mental Health Crisis Team Shelters & Police

Our Approach Client centered approach Collaborative care Sensitive to the unique needs of the elderly Bilingual Case conferences as needed

What do we actually do? Establish diagnosis and provide follow-up Monitoring of treatment (response/compliance/side effects) Provide education and support to family and/or client (illness / services available / options re: future planning) Facilitate acceptance of services and review implementation Advocate for our clients

Psychiatric Diagnosis Common Diagnosis Psychiatric Diagnosis Anxiety Depression Psychotic disorder Dementia Alzheimer dementia with agitation Frontotemporal dementia with agression or impulsive behaviours Lewy Body dementia with disturbing visual hallucinations

Who not to refer Client presenting with: memory problems without any behavioural or psychological symptoms multiple unstable medical conditions depression but is less than 65 years of age

Partnerships Geriatric Assessment Outreach Team (GAOT) Discharge planners CCAC Residential facilities Ottawa Mobile Crisis Team Community Agencies & support programs Housing programs Police and Shelters Elisabeth Bruyère Research Institute Alzheimer Society of Ottawa Geriatric Assessment Unit (GAU) Acute care hospitals & ROMHG Public Guardian & Trustee Lifestyle Enrichment for Senior Adults (LESA)

Geriatric Psychiatry Community Services of Ottawa Main focus: diagnosis psychiatric condition & follow up diagnosis and follow-up (dementia + behaviour issues/ psychiatric symptoms) Referral from physician for psychiatric consults and other professionals if there is already a diagnosis Emphasis is on consultation services (assessment) and follow-up In home assessment by counselors Disciplines: Geriatric Psychiatrist, Social Worker, Nursing and Occupational Therapist

Memory Disorder Clinic Main focus: diagnosis of dementia (any stage) Referral from Physician No age limitation Function at a high level (no complex physical, psychiatric, mental retardation, head injury etc.) Disciplines: Neurology Geriatric Medicine Neuropsychology Nursing

Geriatric Assessment Outreach Teams Main focus: diagnosis (dementia + concomitant medical problems) Referral from physician, professional, family & client Age: over 60 yrs of age presenting with geriatric problems Emphasis is on multidisciplinary assessment for purpose of diagnosis In home assessment (triage/screening for DH) Disciplines: Occupational Therapist Nursing Social Worker Physiotherapist

Case Presentation #1 62 yr old man Memory impairment (MMSE 24/30) Hypertension (under control) History of TIA’s Living alone and some difficulty managing

Case Presentation #2 77 yr old woman Memory impairment (MMSE 22/30) Many falls in last 6 months (wrist fracture in Nov 06) Hypertension OA (followed by rheumatologist) Diabetes not well controlled Many medications Teary, lack of appetite, lack of sleep and little interest

Case Presentation #3 84 yr old woman MMSE 26/30 Loss of husband 6 months ago Geriatric Depression Scale 9/15 Lack appetite, lack of interest, depressed mood etc. Breast Cancer (followed by Cancer Centre)

Case Presentation #4 Couple: 79 yr old woman & 82 yr old man Wife diagnosed with AD (MMSE 18/30) Husband presents with cognitive difficulties (forgets appt, minimizes wife’s problems) Wife is irritable, verbally aggressive No family Followed by family physician