Geriatric Telepsychiatry: Opportunities, Models, and Outcomes

  • Donald M. Hilty
  • Shilpa Srinivasan
  • Terry Rabinowitz
Chapter

Abstract

Contemporary healthcare is patient-centered in terms of quality care, access, and affordable options. Stepped and integrated care models emphasize customized care, interdisciplinary teamwork, and integration of services based on co-location, shared responsibility, and funding. Telepsychiatry (TP) is as effective as in-person care and has been broadly used to provide psychosomatic medicine (formerly consultation-liaison psychiatry) to primary care and other healthcare settings. The literature reveals that TP leverages a wide range of treatments at a distance to clinics, nursing homes, and patient homes and how telemedicine models of care provide flexibility for TP services to patients, providers, and caregivers. There is steady growth of the TP evidence base, and geriatric patients are as open to using TP as other populations and report high satisfaction. TP outcomes for geriatric patients are comparable to in-person care and quite in parallel with outcomes for patients of all ages. TP also enables more patient points of entry, addresses patient-provider needs-skill mismatches, and leverages other resources. Telemedicine and TP overcome geographical, physical limitations and access to care obstacles. More formal TP research studies and health services effectiveness studies are needed for geriatric patients in culturally diverse populations, related to team-based or interdisciplinary care, and employing full stepped or integrated care models.

Keywords

Older, adults, geriatric, mental, health Assessment, evaluation Treatment, integrated, models, stepped, technology, telemedicine, telemental health Telepsychiatry 

References

  1. 1.
    Akinci F, Patel PM. Quality improvement in healthcare delivery utilizing the patient-centered medical home model. Hosp Top. 2014;92(4):96–104.CrossRefPubMedGoogle Scholar
  2. 2.
    Hilty DM, Ferrer D, Callahan EJ, et al. The effectiveness of telemental health: a 2013 review. Telemed J e-Health. 2013;19(6):444–54.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hilty DM, Yellowlees PM, Parish MB, et al. Telepsychiatry: effective, evidence-based and at a tipping point in healthcare delivery. Psychiatr Clin North Am. 2015;38(3):559–92.CrossRefPubMedGoogle Scholar
  4. 4.
    Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. https://www.census.gov/prod/2014pubs/p25–1140.pdf. Accessed 1 Nov 2016.
  5. 5.
    Jeste DV, Alexopoulos GS, Bartels SJ, et al. Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades. Arch Gen Psychiatry. 1999;56(9):848–53.CrossRefPubMedGoogle Scholar
  6. 6.
    lAgeing. (Online) 2012. At: www.who.int/topics/ageing/en. Last accessed November 1, 2016.
  7. 7.
    Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12(3):240–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Yellowlees PM, Shore JH, Roberts L, et al. Practice guidelines for videoconferencing-based telemental health. Telemed J E-Health. 2010;16(10):1074–89.CrossRefPubMedGoogle Scholar
  9. 9.
    Turvey C, Coleman M, Dennison O, et al. ATA practice guidelines for video-based online mental health services. Telemed J e-Health. 2013;19(9):722–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Hilty DM, Shoemaker EZ, Myers KM, et al. Issues and steps toward a clinical guideline for telemental health for care of children and adolescents. J Child Adolesc Psychopharmacol. 2016;26(3):283–95.CrossRefPubMedGoogle Scholar
  11. 11.
    Sheeran T, Dealy J, Rabinowitz T. Geriatric telemental health. In: Myers K, Turvey CL, editors. Telemental health. Amsterdam: Elsevier; 2013. p. 171–95.CrossRefGoogle Scholar
  12. 12.
    Rabinowitz T, Murphy KM, Amour JL, et al. Benefits of a telepsychiatry consultation service for rural nursing home residents. Telemed J e-Health. 2010;16(1):34–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Conn DK, Madan R, Lam J, et al. Program evaluation of a telepsychiatry service for older adults connecting a university-affiliated geriatric center to a rural psychogeriatric outreach service in Northwest Ontario, Canada. Int Psychogeriatr. 2013;25(11):1795–800.CrossRefPubMedGoogle Scholar
  14. 14.
    Urness D, Hailey D, Delday L, et al. The status of telepsychiatry services in Canada: a national survey. J Telemed Telecare. 2004;10:160–4.CrossRefPubMedGoogle Scholar
  15. 15.
    De Las Cuevas C, Arrendondo MT, et al. Randomized controlled trial of telepsychiatry through videoconference versus face-to-face conventional psychiatric treatment. Telemed J e-Health. 2006;12:341–50.CrossRefPubMedGoogle Scholar
  16. 16.
    Fortney J, Pyne JT, Turner E, et al. Telemedicine integration of mental health into rural primary care settings. Int Rev Psychiatry. 2015;27(6):525–39.CrossRefPubMedGoogle Scholar
  17. 17.
    Shore JH, Mishkind MC, Bernard J, et al. A lexicon of assessment and outcome measures for telemental health. Telemed J e-Health. 2013;3:282–92.Google Scholar
  18. 18.
    Elderkin-Thompson V, Silver RC, et al. When nurses double as interpreters: a study of Spanish-speaking patients in a US primary care setting. Soc Sci Med. 2001;52:1343–58.CrossRefPubMedGoogle Scholar
  19. 19.
    Srinivasan S, Jones A, Hilty DM. Geriatric telepsychiatry in academic settings. In: Srinivasan S, Glover J, Bouknight J, editors. Geriatric telepsychiatry. New York, NY: Springer. In Press.Google Scholar
  20. 20.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9. J Gen Intern Med. 2001;16(9):606–13.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983;17(1):37–49.CrossRefGoogle Scholar
  22. 22.
    Phoenix C, Orr N. Pleasure: a forgotten dimension of physical activity in older age. Soc Sci Med. 2014;115:94–102.CrossRefPubMedGoogle Scholar
  23. 23.
    Vahia IV, Ng B, Camacho A, et al. Telepsychiatry for neurocognitive testing in older rural Latino adults. Am J Geriatr Psychiatry. 2015;23(7):666–70.CrossRefPubMedGoogle Scholar
  24. 24.
    Sheeran T, Rabinowitz T, Lotterman J, et al. Feasibility and impact of telemonitor-based depression care management for geriatric homecare patients. Telemed J E-Health. 2011;17:620–6.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Choi NG, Marti CN, Bruce ML, et al. Six-month post-intervention depression and disability outcomes of in-home telehealth problem-solving therapy for depressed, low-income homebound older adults. Depress Anxiety. 2014;31(8):653–61.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Dobbins ML, Roberts N, Vicari SK, et al. The consulting conference: a new model of collaboration for child psychiatry and primary care. Acad Psychiatry. 2011;35:260–2.CrossRefPubMedGoogle Scholar
  27. 27.
    Odor A, Yellowlees PM, Hilty DM, et al. PsychVACS: a system for asynchronous telepsychiatry. Telemed J E-Health. 2011;17(4):299–303.CrossRefPubMedGoogle Scholar
  28. 28.
    Yellowlees PM, Odor A, Parish MB, et al. A feasibility study of asynchronous telepsychiatry for psychiatric consultations. Psychiatr Serv. 2010;61(8):838–40.CrossRefPubMedGoogle Scholar
  29. 29.
    Hilty DM, Marks S, Wegeland JE, et al. A randomized controlled trial of disease management modules, including telepsychiatric care, for depression in rural primary care. Psychiatry. 2007;4(2):58–65.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Myers KM, Vander Stoep A, Zhou C. Effectiveness of a telehealth service delivery model for treating attention-deficit hyperactivity disorder: results of a community-based randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2015;54(4):263–74.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Hilty DM, Johnston B, McCarron RM. How telemental health adds to traditional outpatient and newer models of integrated care for patients, providers and systems. In: Mucic D, Hilty DM, editors. Key issues in e-mental health. New York, NY: Springer; 2015. p. 129–50.Google Scholar
  32. 32.
    Hilty DM, Chan S, Torous J, et al. New frontiers in healthcare and technology: internet- and web-based mental options emerge to complement in-person and telepsychiatric care options. J Health Med Inform. 2015;6(4):1–14.Google Scholar
  33. 33.
    Williams K, Pennathur P, Bossen A, et al. Adapting telemonitoring technology use for older adults: a pilot study. Res Gerontol Nurs. 2015;2:1–7.Google Scholar
  34. 34.
    Ament BH, Wolfs CA, Kempen GI, et al. The benefit of a geriatric nurse practitioner in a multidisciplinary diagnostic service for people with cognitive disorders. BMC Res Notes. 2015;8:217.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Pedone C, Rossi FF, Cecere A, et al. Efficacy of a physician-led multiparametric telemonitoring system in very old adults with heart failure. J Am Geriatr Soc. 2015;63(6):1175–80.CrossRefPubMedGoogle Scholar
  36. 36.
    Lind L, Karlsson D. Telehealth for “the digital illiterate”—elderly heart failure patients’ experiences. Stud Health Technol Inform. 2014;205:353–7.PubMedGoogle Scholar
  37. 37.
    Hilty DM, Rabinowitz T. Telepsychiatry settings: interventions, outcomes and innovations. In: Hategan A, Bourgeois JA, Hirsch C, editors. On call geriatric psychiatry. Cham: Springer; 2016. p. 317–33.CrossRefGoogle Scholar
  38. 38.
    Hilty DM, Nesbitt TS, Marks SL, et al. How telepsychiatry affects the doctor-patient relationship: communication, satisfaction, and additional clinically relevant issues. Prim Psychiatry. 2002;9(9):29–34.Google Scholar
  39. 39.
    Kim T, Biocca F. Telepresence via television: two dimensions of telepresence may have different connections to memory and persuasion. J Comput-Mediat Commun. 1997.  https://doi.org/10.1111/j.1083–6101.1997.tb00073.x.
  40. 40.
    Cukor P, Baer L, Willis BS, et al. Use of videophones and low-cost standard telephone lines to provide a social presence in telepsychiatry. Telemed J. 1998;4(4):313–21.CrossRefPubMedGoogle Scholar
  41. 41.
    Hoffman P, Kane JM. Telepsychiatry education and curriculum development in residency training. Acad Psychiatry. 2015;39(1):108–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Glover JA, Williams E, Hazlett LJ, et al. Connecting to the future: TP in postgraduatemedical education. Telemed J E-Health. 2013;19(6):1–6.CrossRefGoogle Scholar
  43. 43.
    Hilty DM, Rabinowitz T, Yellowlees PM, et al. “Telepsychiatry’s evidence base shows effectiveness: new models (asynchronous), more psychotherapy, and innovations with special populations (Child, Gero, Other)”, Symposium, American Psychiatric Association, Toronto, Canada, 2015.Google Scholar
  44. 44.
    Hilty DM, Crawford A, Teshima J, et al. A framework for telepsychiatric training and e-health: competency-based education, evaluation and implications. Int Rev Psychiatry. 2015;27(6):569–92.CrossRefPubMedGoogle Scholar
  45. 45.
    Royal College of Physicians and Surgeons, CanMEDS Framework. 2015. At: http://canmeds.royalcollege.ca/en/framework. Last accessed November 1, 2016.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Donald M. Hilty
    • 1
  • Shilpa Srinivasan
    • 2
  • Terry Rabinowitz
    • 3
  1. 1.Northern California Veterans Affairs Health SystemMatherUSA
  2. 2.Palmetto HealthColumbiaUSA
  3. 3.University of Vermont Medical CenterBurlingtonUSA

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