Geriatric Psychiatry Program

Transcript of video about Allina Mental Health's Geriatric Psychiatry Program

Mental illness is a real and treatable medical condition, but it is not a normal part of aging. Still, many older adults do experience mental illnesses such as depression, as well as memory loss and deterioration of cognitive skills due to conditions such as dementia and stroke.

These problems are magnified when a mental illness directly interferes with medical conditions common in the elderly, such as heart disease, hypertension, or stroke. If an older patient cannot accurately communicate their medical symptoms due to a mental illness, proper treatment becomes difficult, and other medical complications may arise as a result.

The problem can become even more severe when the geriatric patient is treated as two different people – a psychiatric patient and a medical patient.

Ramesh Sairam, MD, geriatric psychiatrist, medical director, Geriatric Mental Health Program, United Hospital: "As soon as a person has some psych problems – or psychiatric problems – they're quickly labeled as being a 'pysch patient.' And this kind of curtain comes in where people distance themselves, partly because, you know, the average medical floor – or medical physician – is just not as well-trained or has the comfort level in managing complex psychiatric issues, especially in the elderly.

These patients do need a specialist unit where at every level the staff has the expertise to take care of both of these problems at the same time, rather than splitting the patient into a 'psych patient' and a 'medical patient.'"

Penny Wheeler, MD, chief clinical officer, Allina Hospitals & Clinics: "We really need to have a whole person approach. This is what these units allow. This approach allows us to even expand beyond that whole person mentality and involve families."

The geriatric mental health care teams at United and Unity hospitals are comprised of experienced health care professionals who specialize in every aspect of health care necessary to treat this specific patient group.

Joseph McRaith, MD, medical director, Geriatric Mental Health Program, United Hospital: "In the morning we meet for 15 minutes to a half-hour to talk about all of the patients. Everyone gives their input – the RNs, the PCAs. If I have anything to help educate the staff on their medical problems, I give it as well. So, when you leave that meeting all of their problems have been addressed and they're sort of melted into one treatment plan."

Another distinct advantage of the Geriatric Mental Health Program is environmental. The psychiatric and medical needs of a geriatric patient are often at odds with each other in the wrong environment and can significantly slow the recovery process.

Ramesh Sairam, MD, geriatric psychiatrist: "From within the hospital itself, we have found that we've been able to take some patients off the medical floor – where the busy, somewhat noisy environment can sometimes make the mental health problems worse. Whereas the quiet structure of a supportive environment often helps them calm down quicker, the use of less medications, and also they heal and recover quicker from their medical issues as well."

Helping to alleviate stress and confusion does not only apply to the geriatric mental health patient. The patient's family often has special needs and concerns. Experienced team members are always available to answer questions and offer support to families.

Adrienne Olson, licensed social worker, Geriatric Mental Health Program, Unity Hospital: "When families come here, typically it is a time of crisis. Their loved one is experiencing an episode – whether it's with their dementia or other mental illness that can't be managed in their assisted living or their nursing home. But it's also nice to be able to relate to the families, you know, 'Your mom is doing really good today. She seems a lot more upbeat, a lot more positive. I think she's getting ready to discharge.' Just being able to support these families – I really feel a lot of satisfaction helping the families through this."

The Geriatric Mental Health Programs at United and Unity hospitals were not created exclusively for local residents. Geriatric patients at health care facilities all over the metro area can benefit from the services that these programs provide.

Ramesh Sairam, MD, geriatric psychiatrist: "There are many hospitals with adult psychiatric units where they have to house geriatric patients, and it's clearly a mismatch; the programs that are designed for younger adults don't often meet the needs for the elderly. So, many of these hospitals know that if they have a patient that would benefit from a geriatric psychiatry unit they can just pick up the phone and call us."

Other types of facilities that often house geriatric residents – particularly nursing homes – are often simply not equipped or prepared to deliver adequate treatment to those residents who suffer from mental illness or behavioral issues. The result has all-too-often been a revolving-door process that has no positive effect on the patient.

Ramesh Sairam, MD, geriatric psychiatrist: "In the past they would have to send all these patients to emergency rooms – which itself is a nightmarish scenario for an elderly confused person. And now that we have got the word out to the mission of our unit, they call us directly. And so we've been able to minimize some of these distressing emergency room visits."

As America grows older and the health care demands of the population continue to change, the entire health care system must also evolve to meet these needs and other challenges that will certainly arise.

Paul F. Goering, MD, psychiatrist: "We're going to have lots of people who are older. We need to anticipate it. And we have a great shortage of psychiatrists and geriatricians. And as long as we have those two issues combined, we're going to have to be able to look upstream."

Penny Wheeler, MD, chief clinical officer, Allina Hospitals & Clinics: "The geriatric psychiatry units perfectly fit with Allina's care model. They support and anticipate the medical and psychiatric needs in a holistic approach and prevent further complications requiring acute care treatment, which is in many ways more disorienting and harmful to these patients than anyone else."

And yet despite all the planning and preparation that will is necessary to adjust to the needs of an aging population, there remains one aspect of the health care professional's job that should never change – a simple desire to help, which will always provide opportunities to learn and grow.

Alan Dahl, RN, staff nurse, geriatric psychiatry unit, Unity Hospital: "I love working on my unit because it seems like I hear all of this wisdom, and I hear all of this knowledge everytime I meet someone older. They have cognitive issues, but there's so much that you can learn from them. Sometimes it just brings you to tears when you see someone who is so active and productive their whole life long, and then all of the dementia issues start rearing their ugly head. And their whole world starts falling apart. You just can't help but want to help."

Allina Mental Health's Geriatric Psychiatry Program

United Hospital 333 North Smith Avenue, St. Paul, MN 55102 651-241-8860

Unity Hospital 550 Osborne Road, Fridley, MN 55432 763-236-4464