Friday, March 18, 2011 1:00 PM – 2:30 PM Session 102 HOW CAN WE GET RESEARCH FINDINGS INTO PRACTICE? RESULTS FROM THREE NATIONAL PROGRAMS ON IMPLEMENTING EVIDENCE-BASED PRACTICES FOR GERIATRIC DEPRESSION Stephen Bartels, MD, MS1, Jürgen Unützer, MD, MPH2, Mark Snowden, MD, MPH2, Martha L. Bruce, PhD, MPH3 1Dartmouth Medical School, Lebanon, NH 2University of Washington, Seatle, WA 3Weill Cornell Medical College, White Plains, NY Abstract: A "quality chasm" has been extensively described between published findings identifying evidence-based practices by researchers and "real life" clinical practice in the community of health care providers. This widely recognized "implementation gap" has recently spawned an emerging field of "mental health implementation science" as a discipline in its own right that is dedicated to identifying and measuring the essential components and processes necessary to effectively translate research findings into routine use by heath care providers. In this session we will provide early findings from three examples of national programs aimed at implementing selected evidence-based programs for the treatment of geriatric depression. First, we will begin with a brief overview of general principles derived from research on implementation science. Second, Dr. Jürgen Unützer will provide a summary of lessons learned and findings from an innovative web-supported approach to providing training, dissemination, outcome assessment, and technical assistance for implementing the IMPACT collaborative model of depression care management in primary care to approximately 500 practices around the country. Third, Dr. Mark Snowden will provide an overview of implementation findings on the PEARLS model of community outreach and treatment for geriatric depression, including validation of a measure of implementation fidelity instrument, use of "coaching" to improve implementation by addressing barriers/facilitators to implementation and adaptation of PEARLS to non English-speaking older adults. Finally, Dr. Steve Bartels will summarize the technical assistance process and resulting implementation and patient-level outcomes from ten different grantees of SAMHSA's Geriatric Evidence-based Mental Health Demonstration program spanning primary care, community-outreach, and systems integration models of care for geriatric depression. A discussion of implications for clinical practice and future research lead by Dr. Martha Bruce will complete the program. Faculty Disclosures: Stephen Bartels, MD, MS Consultant: SAMHSA/NASMHPD Martha L. Bruce, PhD, MPH Consultant: Medispin, Inc. Mark Snowden, MD, MPH Nothing to disclose Jürgen Unützer, MD, MPH Nothing to disclose
Session 103 EDUCATING THE NEXT GENERATION OF PHYSICIANS IN GERIATRIC PSYCHIATRY Randall Espinoza, MD, MPH1, Lissy Jarvik, MD, PhD2, Stephen Read, MD2, Aaron H. Kaufman, MD1 1UCLA, Los Angeles, CA 2Greater Los Angeles VA Health System, Los Angeles, CA Abstract: Changes in healthcare are accelerating and keeping abreast of developments impacts every discipline and patient group. However, given the vast number of and the diversity found among older adults, these challenges are even more pronounced in the field of geriatrics, and yet, it is critical that Geriatric Psychiatry fellowship programs provide the most current knowledge and practical training to meet the evolving demands of this growing cohort. The diversity of problems found in the geriatric population necessitates a broad familiarity with a variety of assessment tools, interventions and practice settings. Obtaining mastery of this knowledge and proficiency in this skill set are the goals of present fellowship training. However, while ACGME program requirements have recently begun to address proficiency across six core competencies, much of what is taught during a fellowship year essentially reflects the opinion of experts in the field, who are tasked with envisioning what the future world of care might be. Thus, updates to training requirements or educational policy can often lag behind emerging technical advances and may not adequately account for rapid shifts in practice patterns or delivery models. In view of these challenges, and perhaps in recognition of the limitations of a “one size fits all at all times” philosophy, ACGME policy mandates that a form of continuous quality improvement occurs at a program level as a prerequisite of accreditation. We present in this symposium the experience of undertaking these periodic internal reviews at the UCLA Geriatric Psychiatry Fellowship Training Program which is now 30 years in existence. The first presentation is by Lissy Jarvik, MD, one of the pioneers of the field and a force behind the establishment of research and training centers across the country. She discusses how she and her cohorts defined the purview of geriatric psychiatry, what the main challenges were to the field’s formation and continuation, and what was envisioned as the future of practice back then. In the second presentation, Randall Espinoza, MD, current Training Director, provides a brief overview of current ACGME policy addressing program evaluation and discusses the results of a survey of all graduates of the UCLA fellowship that specifically queried whether what was taught during fellowship training adequately anticipated their future practice needs. Next, Stephen Read, MD, presents a new curriculum in forensic psychiatry with special focus on the geriatric population that was designed in response to identification of this need by recent graduates. Lastly, Aaron Kaufman, MD, describes a new curriculum in Research Training and Academic Writing that similarly grew out of feedback from recent graduates who indicated that this topic would be useful in meeting the goal of life-long learning. Faculty Disclosures: Randall Espinoza, MD, MPH Nothing to disclose Lissy Jarvik, MD, PhD Nothing to disclose Aaron H. Kaufman, MD Nothing to disclose Stephen Read, MD Nothing to disclose Session 104 MAINTENANCE OF CERTIFICATION AND THE PERFORMANCE IN PRACTICE COMPONENT: SAMPLE TOOLS FOR THE CARE OF PATIENTS WITH DEPRESSION. Muhammad Aslam, MD1, Christopher C. Colenda, MD,MPH2, Melinda S. Lantz, MD3, Daniel D. Sewell, MD4 1University of Cincinnati, Cincinnati, OH 2West Virginia University, Morgantown, WV 3Albert Einstein College of Medicine, New york, NY 4University of California, San Diego, San Diego, CA
Abstract: As mandated by the American Board of MedicalSpecialties, the ABPN developed a 10-year Maintenance of Certification (MOC) Program which includes 4 components: Professional Standing; Self-Assessment and Lifelong Learning; Cognitive Expertise; and Performance in Practice (PIP). This symposium will explain the MOC Program and review the requirements of the PIP Clinical and Feedback Modules by demonstrating the use of example audit tools on actual patient charts or peer and patient feedback forms. Faculty Disclosures: Muhammad Aslam, MD Nothing to disclose Christopher C. Colenda, MD, MPH Nothing to disclose Melinda S. Lantz, MD Nothing to disclose Daniel D. Sewell, MD Shareholder: Traveling Educational Presentations, Inc Grant funding: The John A. Hartford Foundation; National Institute of Mental Health Other: The Healthcare Group Inc; Lippincott Williams & Wilkins; The American Geriatrics Society Session 105 PRACTICAL APPROACHES TO PSYCHOTHERAPY WITH OLDER ADULTS Marc E. Agronin, MD1, Patricia A. Arean, PhD3, Ken Schwartz, MD, FRCPC2 1Miami Jewish Health Systems, Miami, FL 2Baycrest Centre, Toronto, ON, Canada 3UC-San Francisco, San Francisco, CA Abstract: The use of psychotherapy in the treatment of psychiatric illness in late life sometimes takes a backseat to pharmacologic strategies. However, a growing body of evidence supports the efficacy of several forms of psychotherapy, particularly when used with late-life mood and anxiety disorders. These approaches can even be used successfully with individuals suffering from mild to moderate degrees of cognitive impairment. Problem Solving Therapy (PST) is one efficacious form of psychotherapy for ambulatory older adults, older adults with physical disabilities and older adults with mild cognitive impairment. PST has been shown to be as effective as medication management for depression and in some cases better than other evidence-based psychotherapies in treating major depression in late life. It has also been shown to be effective in preventing depression in high risk populations. PST is a flexible intervention in that it can be delivered in primary care settings, over the telephone, as an individual intervention or as a group based intervention. Providers with or without a mental health background can learn to deliver PST. Group psychotherapy with older adults is another efficacious and cost-effective treatment. Unfortunately, it remains under-utilized as many clinicians remain unaware of its benefits and technique. Benefits of group therapy with this population include members receiving help to recognize their fears, express feelings of loss, discuss community supports, increase awareness of attitudes about death, cope with loneliness, deal more effectively with interpersonal problems and provide affirmation of one another. Faculty Disclosures: Marc E. Agronin, MD Nothing to disclose Patricia A. Arean, PhD Nothing to disclose Ken Schwartz, MD, FRCPC Nothing to disclose
2:45 – 4:15 PM Session 106 INNOVATIONS IN MENTAL HEALTH INTERVENTIONS FOR OLDER LATINOS Patricia A. Arean, PhD1, Ladson Hinton, MD3, Maria Aranda, PhD2 1UCSF, San Francisco, CA 2University of Southern California, Los Angeles, CA 3UC Davis, Davis, CA Abstract: Older Latinos face a number of barriers to accessing high quality mental health care. This disparity is due in part to under recognition of mental illness in these communities, the lack of a bilingual/bicultural workforce that can provide high quality EBTs and cultural barriers endemic to the community services that are most likely to serve older Latinos. The first study presented in this symposium will cover the differences in the recognition and service use among older immigrant and US born Latino males. The second paper will present data on best practices for tailoring evidence based treatments for older Latinos, using Bernal's cross cultural strategies; the third paper will present data on successful EBP training methods for bilingual/bicultural mental health service providers; the final paper will present data on the challenges of implementing EBPs in community settings serving older Latinos. All data from these studies will be helpful to providers and community agencies who wish to increase EBP access to their older Latino community as well as researchers who wish to conduct interventions research in Latino community settings. Faculty Disclosures: Maria Aranda, PhD Nothing to disclose Patricia A. Arean, PhD Nothing to disclose Ladson Hinton, MD Nothing to disclose Session 107 BABY BOOMERS AND SUBSTANCE ABUSE: RECOGNITION, ASSESSMENT AND EVIDENCE-BASED TREATMENT IN THE CLINICAL SETTING Juan Carlos Cleves-Bayon, MD, Paul Kirwin, MD, Louis Trevisan, MD, Bryan Shelby, MD Yale School of Medicine Psychiatry Department, West Haven, CT Abstract: Due to the large population size and high rate of substance use in the Baby Boomer cohort, the number of older adults with substance use disorders is projected to double to almost 6 million in the next ten years. According to the federal report, the trailing edge of the baby boomers, age 50-54, is the fastest growing older group of older addicts. This increase in numbers is causing already a tidal wave of baby boomers needing help for addictions. The workshop will focus on involving participants in an active decision making process. We will demonstrate a systematic and evidence-based approach for the evaluation and treatment of substance abuse in this aging group of baby boomers. This will be accomplished through a combination of didactic presentations, videotaped interview vignettes, and audience participation using a participatory discussion format at strategic points in the clinical management of cases. The didactic presentations will focus on the epidemiology, assessment techniques including use of standardized questionnaires, laboratory and medical assessments, specialized treatment approaches (pharmacologic, psychotherapeutic and psychosocial). Based on case presentations, participants will learn to better identify problematic substance abuse using knowledge of risk factors, differential diagnostic systems and available screening tools. Special emphasis will be placed on pharmacologic interventions involving consideration of dose and drug-drug interactions. In addition, non-pharmacologic interventions, including the use of brief interventions, psychosocial interventions and formal addiction treatment will also be reviewed. This format is designed to educate and help guide the participants in making decisions based on real-life patient cases concerning identification of problems, making accurate assessments and treatment interventions, and developing goals for substance abuse treatment in the aging baby boomer/geriatric patient.
Faculty Disclosures: Juan Carlos Cleves-Bayon MD Nothing to disclose Paul Kirwin MD Nothing to disclose Bryan Shelby MD Nothing to disclose Louis Trevisan MD Nothing to disclose Session 108 PROVIDING PSYCHIATRIC SERVICES FOR HARD TO SERVE POPULATIONS: HOW TO REACH HOLOCAUST SURVIVORS IN THE COMMUNITY Alessandra Scalmati, MD, PhD1, Gary J. Kennedy, MD1, Elihu Kover, MSW2 1Montefiore Medical Center, Bronx, NY, NY 2Self Help Community Services, New York, NY Abstract: Survivors of the Holocaust are a vanishing cohort. However, because of their history of trauma, they are more likely to experience distress in response to the loss of loved ones and independence common in late life. The legacy of trauma increases their need for psychiatric services, and it also increases their sensitivity to stigma and mistrust of authority. Of the worldwide population of Survivors, 16% live in the US, 50% of that number, or 54,500 in the New York City area. Their median age in 2008 was 78. The projection of their psychiatric needs is expected to increase dramatically over the next decade. Selfhelp Nazi Victim Services is a community-based agency dedicated to providing supportive services to Holocaust Survivors in the New York City area. They often face the challenge of being unable to provide psychiatric referral for their clients, because of lack of appropriately trained geriatric psychiatrists sensitive to the specific issues of traumatized elderly. The Bronx Holocaust Survivor Project is a collaborative mental health program between the Selfhelp Bronx and Washington Heights Nazi Victim Services Program and the Division of Geriatric Psychiatry of Montefiore Medical Center. The project was initiated in November of 1999, and it has 2 components. A part time Geriatric Psychiatrist is available for direct consultation and referrals; many patients were seen in their home. The reasons for referral ranged from simple treatment of anxiety to complex capacity assessments that led to guardianship. Some cases were one time consultations, the majority though required extensive involvement and ongoing care. It was also possible to refer many patients to the Montefiore Geriatric Medical Division, where fellows and nurse practitioners could see patients in their home or at the clinic. The second element of the collaboration is the training and support of the staff of the Agency. Working with a victim of trauma is a source of distress for any staff member who becomes familiar with the details of the patient’s history. The geriatric psychiatrist provided in-service training twice a year to the larger group of workers from the entire metropolitan area on prearranged topics. Moreover, she met monthly with the case workers from the Bronx and Washington Heights areas. This model offers multiple advantages: only one part time geriatric psychiatrist with expertise in trauma work could provide indirect consultation on a large number of cases. The regular meetings ensure the possibility of follow up on complex cases that require ongoing monitoring, without need for direct involvement by the psychiatrist. The staff members feel empowered and supported, and the monthly meeting often works as a combination of supervision and support group, providing an opportunity to both vent and strategize. In conclusion, Holocaust Survivors are an aging traumatized population whose numbers are declining at the same time that their needs are increasing. Even though the last of the survivors will likely die within the next two decades what we can learn from providing services to this group can be applied with other victims of trauma. Faculty Disclosures: Gary J. Kennedy, MD Nothing to disclose Elihu Kover, MSW Nothing to disclose
Alessandra Scalmati, MD, PhD Nothing to disclose Session 109 THE NEW FRONTIER: MOVING GERIATRIC PSYCHIATRY FELLOWSHIP TRAINING INTO COMMUNITY INTERDISCIPLINARY SETTINGS Monica S. Lewis, PhD1, Steven Huege, MD1, Lisa L. Boyle, MD2, Ashley A. Harmon, MD2 1Philadelphia VA Medical Center, Philadelphia, PA 2University of Rochester School of Medicine and Dentistry, Rochester, NY Abstract: As the population of older adults continues to rise and access to mental health services becomes a growing problem, novel approaches to delivering quality interdisciplinary mental health services are necessary. This symposium will highlight opportunities to capitalize on innovative new models of mental health services delivery through development of formal geriatric psychiatry training opportunities that will allow fellows (and other trainees) to learn how to work within non-traditional settings as members of interdisciplinary teams. This symposium will focus on the development of two new rotations that provide trainees the opportunities to join an interdisciplinary team to deliver mental health services in settings outside of the traditional clinic (i.e., community social services setting and VA home-based primary care clinic). The presenters will share with the audience the “lessons learned” with developing and implementing these types of training opportunities, teaching and training strategies used to facilitate the work of the interdisciplinary team, and the curricula that has been developed. There will be time for audience participation to facilitate sharing of others’ experiences and ideas. Faculty Disclosures: Lisa L. Boyle, MD Nothing to disclose Ashley A. Harmon, MD Nothing to disclose Steven Huege, MD Nothing to disclose Monica S. Lewis, PhD Nothing to disclose Session 110 INCORPORATING MEASUREMENT AND SCALES INTO CLINICAL PRACTICE Maureen C. Nash, MD, MS1, Amita R. Patel, MD2 1Tuality Center for Geriatric Psychiatry, Forest Grove, OR 2Wright State University, Dayton, OH Abstract: Evidence Based Medicine requires measurement. In primary care, they can use the HgbA1C to track diabetes and pulmonary function tests or pulse oximetry to track COPD. Psychiatry has no laboratory tests to use to track the severity of illness or the effectiveness of treatment. Psychiatry does have access to a large number of clinical tools in the form of rating scales which have been tested in tracking severity of illness and efficacy of treatment. This session will allow two experienced geriatric psychiatrists to review how and why they use rating scales and measurement in their practices. After attending this session, you will feel comfortable evaluating what types of scales to use and how to incorporate them into your practice. As evidence based medicine has become the prevailing clinical framework for mental health, it is essential that we incorporate the use of various scales for measuring symptom severity and response to treatment. This seminar will also focus on training families/patients to do self assessment scales and promote use of evidence based guidelines and clinical interventions with more emphasis on patient self-education and self management. Faculty Disclosures: Maureen C. Nash, MD, MS Nothing to disclose
5:00 – 6:30 PM OPENING PLENARY AND AWARDS SESSION Allan A. Anderson, MD Samuel and Alexia Bratton Memory Clinic, Easton, MD Presidential Address: Meeting the Challenges in Geriatric Mental Health: Directing Our Future Faculty Disclosures: Allan A. Anderson, MD Research Support: Novartis; Pfizer; Medivation; Lilly
Saturday, March 19, 2011 9:45 AM – 11:15 AM Session 202 DISPARITIES IN MENTAL HEALTH SERVICES: MOVING FROM DESCRIPTION TO INTERVENTIONS Joseph J. Gallo, MD, MPH1, Annelle B. Primm, MD, MPH2, Charlotte Brown, PhD3, Jin Hui Joo, MD1, Earlise C. Ward, PhD4 1University of Pennsylvania, Philadelphia, PA 2American Psychiatric Association, Washington, DC 3University of Pittsburgh, Pittsburgh, Pennsylvania, PA 4University of Wisconsin, Madison, Wisconsin, WI Abstract: The mental disorders of late life constitute one of the most pressing global public health issues of the 21st Century. Disparities in mental health care persist among older adults and action, not further description, is needed to address the suffering and increased mortality older adults experience due to depression and other conditions. Addressing the psychiatric and behavioral disturbances of older adults in the coming decades is all the more challenging when one considers demographic trends, patterns of service use and delivery, and the training and composition of the health care work force. Because older adults often do not use specialty mental health services, may be reluctant to take medication for depression, and have accompanying medical co-morbidity that complicates identification and management of depression, new models of intervention development and service delivery are needed. Speakers in this symposium will set forth a conceptual framework for academic-community partnerships and will provide examples of community-based interventions that promise to mitigate mental health disparities. The discussant will be led by Director of the Department of Minority and National Affairs of the American Psychiatric Association. The session will help lay the groundwork for developing strategies for interventions directed at disparities. Faculty Disclosures: Charlotte Brown, PhD Nothing to disclose Joseph J. Gallo, MD, MPH Nothing to disclose Jin Hui Joo, MD Nothing to disclose
Annelle B. Primm, MD, MPH Nothing to disclose Earlise C. Ward, PhD Nothing to disclose Session 203 E&M CODING AND DOCUMENTATION: A WORKSHOP David Greenspan, MD, FAPA Carrier Clinic, Belle Mead, NJ Abstract: This workshop will review the basics in E&M service delivery, corresponding documentation and associated CPT codes. It will contrast these services to psychotherapy services and their corresponding documentation. The review will be followed by documentation examples focusing on tips and traps in the coding process. Faculty Disclosures: David Greenspan, MD, FAPA Nothing to disclose Session 204 NEW RESEARCH IN PSYCHIATRIC SYMPTOMS IN PARKINSON'S DISEASE AND APPLICATIONS FOR CLINICAL PRACTICE William M. McDonald, MD1, Laura Marsh, MD3, Daniel Weintraub, MD2 1Emory University Medical School, Atlanta, GA 2University of Pennsylvania, Philadelphia, PA 3Baylor College of Medicine, Houston, TX
Abstract: William McDonald MD (J.B. Fuqua Professor in the Department of Psychiatry and Behavioral Sciences and Chief of the Division of Geriatric Psychiatry at Emory University): Depression in Parkinson’s disease (dPD). Dr. McDonald will review the neurobiology, epidemiology and treatment of dPD. Dr. McDonald will also present new data on the use of atomoxetine and dopamine agonists in dPD and data from the most recent multicenter trial comparing an SSRI to an SNRI (Serotonergic Antidepressants in PD or SADPD). Laura Marsh MD (Professor in the Department of Psychiatry, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine): Anxiety in PD. Dr Marsh will review the neurobiology, epidemiology and treatment of anxiety disorders in PD. Dr. Marsh will also review results of a recent study to determine the prevalence and clinical correlates of all DSM-IV-TR anxiety disorder diagnoses in a sample of 127 subjects with idiopathic PD who underwent comprehensive assessments administered by a psychiatrist and neurologist. Daniel Weintraub MD (Associate Professor of Psychiatry at the Hospital of the University of Pennsylvania; Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Philadelphia VA Medical Center): Impulse control disorders and Mild Cognitive Impairment in PD. There is an increasing awareness that impulse control disorders (ICDs), including compulsive gambling, buying, sexual behavior and eating, can occur as a complication of PD. In addition, other disorders including dopamine dysregulation syndrome (DDS) and punding are reported. Dr. Weintraub will review recent data from a cross sectional study of over 3,000 PD patients which adds further support to an association between dopamine-replacement therapies and ICDs in PD, and will also discuss various management strategies. Dr. Weintraub will also review date on mild cognitive impairment (MCI) in PD, as up to 80% of PD patients develop dementia (PDD) long-term. Identification and management of cognitive deficits at their onset is important in PD, and there is emerging epidemiological, imaging, and biomarker research that sheds additional light on MCI in PD. Faculty Disclosures: Laura Marsh, MD Research Support: Forest Research Institute; Boeringer-Ingelheim William M. McDonald, MD
Research Support: Wyeth Pharmaceuticals; Glaxo Smith Kline; Neuronetics; Boehinger Ingelheim; Janssen Speakers Bureau: Janssen Daniel Weintraub, MD Consultant: Novartis; Boehringer Ingelheim Session 205 GERIATRIC MENTAL HEALTH SERVICES RESEARCH: A DISCUSSION FOR EARLY CAREER INVESTIGATORS Martha L. Bruce, PhD, MPH1, Stephen Bartels, MD, MS2, Jürgen Unützer, MD, MPH, MA3, Frederic C. Blow, PhD4 1Weill Cornell Medical College, White Plains, NY 2Dartmough Medical School, Lebanon, NH 3University of Washington, Seattle, WA 4University of Michigan, Ann Arbor, MI Abstract: This session is geared to postdoctoral fellows and other early career investigators interested in geriatric mental health services research, the science focused on improving access to care, quality of care, and outcomes for older adults with mental health problems. The session is led by the four directors of a multi-site (Dartmouth, U. Michigan, U. Washington, Weill Cornell) NIMH T32 training program in “Geriatric Mental Health Services Research”. They will introduce key topics relevant to successful research careers in geriatric mental health services including: Achieving Funding Success through Impact and Innovation in Aging Research Proposals Innovative Methodologies for Moving from Effectiveness to Implementation Community-Based Research Settings and Partnerships in Geriatric Mental Health A Model for Developing a Virtual Multisite Research Mentoring Network These brief talks will provide the backdrop for group discussion. Faculty Disclosures: Stephen Bartels, MD, MS Consultant: SAMHSA/NASMHPD Frederic C. Blow, PhD Nothing to disclose Martha L. Bruce, PhD, MPH Consultant: Medispin, Inc Jürgen Unützer, MD, MPH, MA Nothing to disclose Session 206 SUCCESSFUL MENTORING: DOES GENDER MATTER? Tatyana P. Shteinlukht, MD, PhD1, Marianne E. Felice, MD1, Lance Lichtor, MD1, Barbara Kamholz, MD2 1University of Massachusetts Medical School, Worcester, MA 2Duke University, Durham, NC Abstract: Life can be defined as a learning process. Mentoring is one of the most efficient ways of learning. Mentor/mentee relationship is a mutually enriching process. Successful mentorship can play a pivotal role in professional and personal development/advancement for a mentee and be a rewarding experience for a mentor. Are there differences in mentoring man versus women? Being mentored by a woman versus a man: what is different and how does it matter? Those topics will be presented by two renowned senior mentors: Drs. Marianne E. Felice, MD and J. Lance Lichtor, MD; as well as their female junior faculty mentee Dr. Tatyana Shteinlukht, MD, PhD. Dr. Barbara Kamholz, MD, AAGP Board Member, Immediate past Leader of AAGP Woman’s Interest Group and a devoted and experienced mentor, will offer her insights as a discussant.
Faculty Disclosures: Marianne E. Felice, MD Nothing to disclose Barbara Kamholz, MD Nothing to disclose Lance Lichtor, MD Nothing to disclose Tatyana P. Shteinlukht, MD, PhD Nothing to disclose Session 207 EMERGING FROM BETWEEN A ROCK AND A HARD PLACE: TREATING THE NEUROPSYCHIATRIC SYMPTOMS OF DEMENTIA Helen C. Kales, MD1, Clive Ballard, MD2, Laura Gitlin, PhD3, Constantine Lyketsos, MD,MHS4 1University of Michigan, Ann Arbor, MI 2King's College, London, United Kingdom 3Thomas Jefferson University, Philadelphia, PA 4Johns Hopkins University, Baltimore, MD Abstract: Neuropsychiatric symptoms (NPS) are exceedingly common in dementia and often dominate disease presentation. As compared with research to treat cognitive symptoms, research examining the treatment of NPS is modest and no medication is approved by the US Food and Drug Administration for this indication. Nevertheless, a variety of psychotropic medications, including antipsychotics, anticonvulsants, antidepressants and benzodiazepines, have been used in the treatment of NPS. However, the lack of efficacy and side-effect issues with many of these medications leave clinicians in a difficult situation given the prevalence of troublesome behaviors and the lack of true pharmacological alternatives. Non-pharmacological interventions may be useful as sole treatments or adjuncts to medications in many cases, but many clinicians have not been trained in their use. Using a case-based format, this symposium is intended to provide the clinician with both the state of the art in terms of the evidence-base for various pharmacological and non-pharmacological modalities in the treatment of NPS, as well as expert consensus regarding "smarter prescribing and monitoring". Importantly, using the case, the symposium will also provide a forum to discuss much needed non-pharmacological interventions that can we utilize in real-world practice settings. Faculty Disclosures: Clive Ballard, MD Research Support: Lundbeck Consultant: Acadia Pharmaceuticals; Bristol-Myers Squibb Speakers Bureau: Novartis; Eisai; Lundbeck Laura Gitlin, PhD Nothing to disclose Helen C. Kales, MD Nothing to disclose Constantine Lyketsos, MD,MHS Research Support: NIMH, NIA, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, Glaxo-Smith-Kline, Eisai, Pfizer, Astra-Zeneca, Lilly, Ortho-McNeil, Bristol-Myers, Novartis, National Football League Consultant: Astra-Zeneca, Glaxo-Smith Kline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Genentech Other: Pfizer, Forest, Glaxo-Smith Kline, Health Monitor, NFL Players Association
Session 209 PSYCHOPHARMACOLOGY AND OLDER ADULTS: SAFETY, RISK, AND OPPORTUNITIES Jovier D. Evans, PhD1, Kara Zivin, PhD3, Daniel Weintraub, MD2, David Mamo, MD4, Helen C. Kales, MD3 1National Institute of Mental Health, Bethesda, MD 2University of Pennsylvania, Philadelphia, PA 3University of Michigan, Ann Arbor, MI 4Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada Abstract: Older adults are often underrepresented in clinical trials research. Given the advancing age of the population and the polypharmacy often seen among older adults with mental illness, more work needs to be done examining safety and benefits of psychotropic medications in older adults. Second generation (atypical) antipsychotic medications have been widely used to treat behavioral and psychiatric symptoms of Alzheimer’s disease (AD), but the benefits and risks associated with these medications have caused concern around their use. The FDA black box warning and results of the NIMH supported CATIE-AD trial suggest that adverse effects offset advantages in the efficacy of atypicals to treat these behavioral syndromes in AD. In addition, new advances in clinical neuroscience have pushed for the identification of biomarkers and correlates of treatment response variability. These developments argue for more focused approaches to understanding both the pathophysiology and clinical presentation of symptoms that may serve as new pharmacologic and behavioral targets for research. This symposium will include discussion of findings from large epidemiological studies focusing on safety and outcomes to more specific clinical studies of safety and efficacy of these psychotropic medications among older adults. Examining the Link between Antipsychotics and Mortality in VA National Data Presenter Kara Zivin, Ph.D. Safety Issues with Psychotropic Use in Neurodegenerative Diseases: AD, PD and DLB Presenter Daniel Weintraub, MD Minimizing Exposure to Antipsychotic Drugs with Aging in Schizophrenia: Safety and Feasibility of Dose Reduction Presenter David Mamo, MD Discussant: Helen Kales, MD Faculty Disclosures: Jovier D. Evans, PhD Nothing to disclose Helen C. Kales, MD Nothing to disclose David Mamo, MD Research Support: Pfizer Daniel Weintraub, MD Consultant: Novartis; Boehringer Ingelheim Kara Zivin, PhD Nothing to disclose Session 210 GETTING STARTED IN PRACTICE: HOW TO DO IT RIGHT OR MISTAKES NOT TO MAKE. Alan Siegal, MD, Jeanne Jackson-Siegal, MD Geriatric and Adult Psychiatry LLC, Hamden, CT Abstract: This session with highlight the necessary steps one should take in establishing a private practice in geriatric psychiatry. Areas to be addressed include: office space, negotiating contracts, hiring staff, insurance needs, electronic medical records, billing software, key consultants to work with and how to make a living beyond billing Medicare. Just as important, the session will try to highlight critical errors many have made is getting their practice up and running.
Faculty Disclosures: Jeanne Jackson-Siegal, MD Nothing to disclose Alan Siegal, MD Nothing to disclose Session 211 GAY AND GRAY II: ADDRESSING THE MENTAL HEALTH CARE NEEDS OF OLDER LESBIAN, GAY, BISEXUAL, AND TRANSGENDERED INDIVIDUALS Daniel D. Sewell, MD1, Jordan F. Karp, MD2, Cheryl Claassen, PhD3, Ellen Haller, MD4 1University of California, San Diego, San Diego, CA 2University of Pittsburgh, Pittsburgh, PA 3Appalachian State University, Boone, NC 4University of California, San Francisco, San Francisco, CA Abstract: This symposium will provide clinically useful information regarding the growing number of older LGBT individuals in the U.S. Speakers will summarize some of the best scientific and clinical data available regarding the demography of the aging LGBT community and the epidemiology of psychiatric problems in older LGBT individuals, discuss issues impacting the mental health and well-being of older lesbians, outline challenges faced by older lesbians living in long-term care, and review legal aspects of being gay and older such as the lack of social security benefits for partners/spouses. This session will consist of one 10 minute lecture and two 30 minute lectures followed by 20 minutes of Q&A moderated by the session Chair. Faculty Disclosures: Cheryl Claassen, PhD Nothing to disclose Ellen Haller, MD Nothing to disclose Jordan F. Karp, MD Research Support: Eli Lilly Shareholder: Corcept Consultant: Eli Lilly; Theravance Other: Novartis Daniel D. Sewell, MD Shareholder: Traveling Educational Presentations, Inc Grant funding: The John A. Hartford Foundation; National Institute of Mental Health Other: The Healthcare Group Inc; Lippincott Williams & Wilkins; The American Geriatrics Society Session 212 RESEARCH AWARDS PAPER SESSION This year, AAGP will feature presentations at a single session by all three Research Award winners, providing an opportunity to hear from one of the field’s most eminent scientists and two of the most promising junior researchers. 2011 AAGP Distinguished Scientist Award Lecture: Barry Reisberg, MD The AAGP Distinguished Scientist Award is based on the body of original scientific works accomplished during the course of a career as well as mentorship of the careers of successful contributing junior researchers in the field of geriatric psychiatry. 2011 Barry Lebowitz Early Career Scientist Award: R. Scott Mackin, PhD Patterns of Reduced Cortical Thickness in Late Life Depression and Relationship to Psychotherapeutic Response
R. Scott Mackin, Ph.D., Duygu Tosun-Turgut, PhD, Susanne G. Mueller, MD, Norbert Schuff, Ph.D, Jun-Young Lee, MD, Philip Insel, MS, Diana Truran-Sacrey, BA, Patricia A. Arean, Ph.D & Michael W. Weiner, MD Objective: Cortical atrophy has been associated with late life depression (LLD) and recent findings suggest that right hemisphere cortical thinning is associated with familial risk for major depressive disorder but patterns of cortical thickness in LLD have not yet been explored. Further, cortical atrophy has been posited as a contributor to poor anti-depressant treatment response in LLD but the impact of cortical thickness on psychotherapy response is unknown. This study was conducted to evaluate patterns of cortical thickness in LLD and in relation to psychotherapy treatment outcomes. Methods: Participants included 22 individuals with LLD and 12 age matched comparison subjects. LLD participants completed 12 weeks of psychotherapy and treatment response was defined as a 50% reduction in depressive symptoms. All participants participated in Magnetic Resonance Imaging (MRI) of the brain and cortical mapping of grey matter tissue thickness was calculated. Results: LLD individuals demonstrated thinner cortex than controls prominently in the right frontal, parietal, and temporal brain regions. Eleven participants (50%) exhibited positive psychotherapy response after 12 weeks of treatment. Psychotherapy non-responders demonstrated thinner cortex in bilateral posterior cingulate and parahippocampal cortices, left paracentral, precuneus, cuneus, and insular cortices, and the right medial orbito-frontal and lateral occipital cortices relative to treatment responders. Conclusions: Our findings suggest more distributed right hemisphere cortical abnormalities in LLD than have been previously reported. Additionally, our findings suggest that bilateral cortical thinning may be an important phenotypic marker of individuals at higher risk for poor psychotherapy treatment response. 2011 Member-in-Training Research Award: Adam Simning, BA Mental Health Care Need and Service Utilization in Older Adults Living in Public Housing Adam Simning, B.A., Edwin van Wijngaarden, Ph.D., Susan Fisher, M.S., Ph.D., Thomas M. Richardson, Ph.D., and Yeates Conwell, M.D. Objective: Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have a high concentration of risk factors for anxiety and depression. Design: Cross-sectional study. Setting: Public housing high-rises in Rochester, NY. Participants: 190 respondents aged 60 years and older. Measurements: Anxiety and depression were assessed using the Structured Clinical Interview for the DSM-IV, GAD-7, and PHQ-9. We obtained information on mental health care from medication review and self-report. Results: Participants had a median age of 66 years, 58% were female, 80% were black, and 92% lived alone. Many participants were in need of mental health care: 21% suffered from syndromal and 11% had subsyndromal anxiety or depression. Mental health care need was associated with younger age, not being cognitive impaired, more instrumental activities of daily living (IADL) impairments, increased medical comorbidity, decreased mobility, smaller social network size, more severe life events, and increased utilization of healthcare, human, and informal services. Of those with need, most were not receiving mental health care. Compared to residents receiving care, residents with untreated need were more likely to be male and had less IADL impairment, medical comorbidity, severe life events, onsite social worker use, and human services utilization. Conclusions: Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification and treatment of these mentally ill older adults. Faculty Disclosures: R. Scott Mackin, PhD Nothing to disclose. Adam Simning, BA Nothing to disclose.
Session 213 U.S. AND INTERNATIONAL MODELS OF MENTAL HEALTH OUTREACH CARE FOR THE ELDERLY Deirdre Johnston, MB BCh BAO MRCPsych1, Bernadette Cullen, MB BCh BAO MRCPsych1, Brian Lawlor, MD FRCPsych2, Anne Borjesson-Hanson, MD PhD3, Leon J. Kagan, MD FRCPC4 1Johns Hopkins University, Baltimore, MD 2Trinity College, Dublin, Ireland 3Sahlgrenska University, Gothenburg, Sweden 4University of Alberta, Edmonton, AB, Canada Abstract: As the US health care system undergoes sweeping reform, population aging impels innovation in the provision of mental health services to the rapidly rising numbers of community dwelling elders, many of whom are frail and/or have needs across multiple domains that must be addressed in order to provide effective mental health care. This symposium will present four models of outreach mental health care to the elderly and discuss the challenges faced and the strategies found to be practical and effective in four different social, economic, and geographic settings: the US, Ireland, Sweden, and Canada. Speaker 1 will describe community-based geriatric mental health services in inner city Dublin. Data on resource utilisation will be presented contrasting resource utilisation by late onset and ‘graduate’ patients. Speaker 2 will describe services provided by a multidisciplinary geriatric psychiatry outreach team to community-dwelling residents of Gothenburg, Sweden. Speaker 3 will describe two guided care models of outreach in two urban US locations, one a randomized controlled trial of the model, with preliminary outcome data. Speaker 4 will describe the continuum of mental health care established by collaboration across multiple agencies serving the elderly in Edmonton, Alberta, Canada. Faculty Disclosures: Anne Borjesson-Hanson, MD PhD Nothing to disclose Bernadette Cullen, MB BCh BAO MRCPsych Nothing to disclose Deirdre Johnston, MB BCh BAO MRCPsych Nothing to disclose Leon J. Kagan, MD FRCPC Nothing to disclose Brian Lawlor, MD FRCPsych Nothing to disclose Session 214 THE EARLY IDENTIFICATION OF ALZHEIMER DISEASE Robert A. Sweet, MD1, Frederick W. Unverzagt, PhD3, Clifford R. Jack, Jr, MD2, Meryl A. Butters, PhD1 1University of Pittsburgh, Pittsburgh, PA 2Mayo Clinic, Rochester, MN 3Indiana University, Indianapolis, IN Abstract: It is now widely recognized that the onset of Alzheimer Disease is preceded by a prodrome of mild cognitive impairment. However, not all individuals with mild cognitive impairment will progress to Alzheimer disease. Today’s practitioner needs to know how to identify individuals at risk for progression and therefore likely to benefit from early recognition and intervention. This session will focus on the early diagnosis of Alzheimer Disease, emphasizing multimodal imaging techniques and real-world settings. Dr. Fred Unverzagt will present on the rates of mild cognitive impairment in elderly individuals seen in primary care settings, and the rates and predictors of progression to dementia and Alzheimer disease. Dr. Clifford Jack will review the current state of the art in the use of MRI, FDG- and PIB-PET,
and CSF as aids to the diagnosis of Alzheimer disease. Dr. Meryl Butters will discuss ways in which these approaches inform us about the pathways through which depression may lead to dementia and how treating depression in older adults can minimize the neurotoxic effects. Faculty Disclosures: Meryl A. Butters, PhD Nothing to disclose Clifford R. Jack, MD Nothing to disclose Robert A. Sweet, MD Nothing to disclose Frederick W. Unverzagt, PhD Nothing to disclose
3:30 PM – 5:00 PM Session 216 IS THERE A FUTURE FOR GERIATRIC PSYCHIATRY? Elizabeth J. Bragg, PhD, RN1, Josepha A. Cheong, MD2, Allan A. Anderson, MD3, Constantine Lyketsos, MD4 1University of Cincinnati, Cincinnati, OH 2University of Florida, Gainesville, FL 3Samuel and Alexia Bratton Memory Clinic, Easton, MD 4Johns Hopkins University, Baltimore, MD Abstract: Objective: To document the development of geriatric psychiatry training and practice in the United States through 2009. Methods: A cross-sectional survey of the 56 U.S. geriatric psychiatry fellowship programs was conducted in summer 2007 and findings compared to a similar survey in 2001. Longitudinal data from multiple secondary sources were also analyzed. Results: Thirty-seven (66%) of 56 program directors responded. The number of fellowship programs and fellows-in-training has decreased over the past seven years. During 2007/08, 60 fellows were in training compared to 94 fellows in 2001/02. Application rates declined significantly with a mean of 4.3 applications per program in 2006/07 compared to a mean of 10 in 2001/02. The fill rate for first-year geriatric psychiatry fellowship positions dropped from 61% in 2001/02 to 43% in 2007/08. During 2006/07, 67% of programs reported having two or fewer first-year fellows and 16% had no first-year fellows. Notably, 17 programs reported having no United States medical school graduates as first-year fellows. In contrast, in 2004/05 there were 14 accredited psychosomatic medicine fellowship programs training 6 fellows. Four years later, in 2008/09, the number of psychosomatic programs increased to 40 with 33 fellows in training (Table 1). As of 2009, the ABPN reported 1,705 certified geriatric psychiatrists or 0.9 psychiatrists/10,000 adults 75 and older. The first certification examination in psychosomatic medicine was issued in 2005. As of 2008 there are 853 physicians certified in psychosomatic medicine. Historically, Medicare has required patients to pay a 50% co-insurance on mental health services as compared to 20% for physical health services. This has been a disincentive for psychiatrists and other mental health professionals to specialize in the care of older adults. In 2008, Congress authorized a transition to mental health services co-insurance parity under Medicare. This change, will be phased in starting in 2010, and will result in a reduction of Medicare co-insurance rate for mental services to 20% by 2014. However, another change in Medicare, effective January 1, 2010, elimination of consultation codes, may result in decreased reimbursement for geriatric psychiatrists, particularly those who work at general hospitals or in nursing homes and often are asked to consult on medical and surgical patients. Medicare has instructed physicians to bill for consultations services using the most appropriate evaluation and management codes. The newly recommended codes reimburse from 64% to 90% of the amount reimbursed by the highest level consult code. Conclusion: The number of geriatric psychiatry fellows in training has declined by 39% (94 to 57) between 2001/02 and 2008/09. Even more striking is the decline in the number of advanced fellows from 13 to 1. This decline has occurred at the same time that the number of older adults continues to expand rapidly. Unfavorable cultural and societal attitudes towards the elderly may be a factor as some perceive that the elderly are of little productive value to society, particularly
when the older adult has the added stigma of a mental health problem. It is essential that an adequate number of geriatric psychiatrists be trained to support and educate general psychiatrists and geriatricians in the care of the elderly, and to provide services for the most complex older adults. Specific strategies must be developed urgently to stimulate interest in careers in clinical and academic geriatric psychiatry. Congress recently approved funding for an Institute of Medicine (IOM) study that will focus on the mental health workforce for aging and ethnic population. This IOM study is critical to developing strategies to encourage physicians to train and practice in geriatric psychiatry. Comparison of Geriatric Psychiatry and Psychosomatic Medicine Fellowship Programs
Academic Years Geriatric Psychiatry Psychosomatic Medicine
USMD = United States Medical School Graduates Faculty Disclosures: Allan A. Anderson, MD Research Support: Novartis; Pfizer; Medivation; Lilly Elizabeth J. Bragg, PhD, RN Nothing to disclose Josepha A. Cheong, MD Nothing to disclose Constantine Lyketsos, MD Research Support: NIMH, NIA, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, Glaxo-Smith-Kline, Eisai, Pfizer, Astra-Zeneca, Lilly, Ortho-McNeil, Bristol-Myers, Novartis, National Football League Consultant: Astra-Zeneca, Glaxo-Smith Kline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Genentech Other: Pfizer, Forest, Glaxo-Smith Kline, Health Monitor, NFL Players Association Session 217 POWERS OF ATTORNEY, GUARDIANSHIPS, AND ADVANCE DIRECTIVES IN GERIATRIC PSYCHIATRY David Casey, MD1, Robert P. Roca, MD, MPH, MBA3, Winsor Schmidt, JD, LLM1, Helen H. Kyomen, MD, MS2 1University of Louisville, Louisville, KY 2Harvard Medical School, Boston, MA 3Sheppard Pratt Health System, Towson, MD Abstract: Guardianships, powers of attorney, and other forms of advance directive are frequently encountered in geriatric psychiatry, particularly in dementia care. These arrangements are often vital in clinical decision making, but can present a variety of legal and ethical questions. In this symposium, the panel will address some of these issues and present a representative case for discussion. Guardianship is a legal pathway which allows for the court to make a determination of competence or disability and appoint of one person to make decisions for another. The discussion will include the various types of guardianships, the powers, limits, duties, and responsibilities of guardians, the role of courts in guardianship determinations, and the potential problems physicians may encounter in dealing with guardianships. The panel will also discuss powers of attorney, which are private (rather than court ordered) agreements among individuals designating one or more persons as decision makers for another. Various types of powers of attorney and their applications and potential problems will be discussed. Finally, other types of advance directives (such as psychiatric
advance directives) which may be encountered by geriatric psychiatrists will be explored. Several geriatric psychiatrists will present, along with an attorney who is recognized as one of the nation's leading experts and authors on guardianship and mental health. Faculty Disclosures: David Casey, MD Nothing to disclose Helen H. Kyomen, MD, MS Consultant: Astra Zeneca Pharmaceuticals LP; Bayer Corporation; Bristol-Meyers Squibb Company; Merck & Co., Inc.; Eli Lilly and Company; Roche Pharmaceuticals; Glaxo Smith Kline; Novartis Pharmaceuticals Corporation; UCB Pharma; Wyeth-Ayerst Laboratories; Pfizer Research Support: Bayer Corporation; Bristol-Meyers Squibb Company; Eli Lilly and Company; Roche Pharmaceuticals; UCB Pharma; Wyeth-Ayerst Laboratories; Pfizer Inc.; NIH Institute; The John A. Hartford Foundation; National Institute on Aging; Veterans Administration Robert P. Roca, MD, MPH, MBA Nothing to disclose Winsor Schmidt, JD, LLM Nothing to disclose Session 218 WHERE THE HEART IS: BEHAVIORAL INTERVENTIONS IN HOME CARE Julie Wetherell, PhD2, Dimitris N. Kiosses, PhD1, Amber M. Gum, PhD3 1Weill Cornell Medical College, White Plains, NY 2VA San Diego Healthcare System, San Diego, CA 3University of South Florida, Tampa, FL Abstract: Supporting older people to “age in place” in their homes rather than in institutions is both conducive to well-being and cost-effective. Medicare has identified aging at home as a priority and in 2009 was projected to spend 72.2 billion dollars on home health care; with changing demographics, this amount is anticipated to grow. The increasing emphasis on in-home care has recently been endorsed by Congress and President Obama with the March 23, 2010 signing of the Independence at Home Act, which creates a demonstration program within the Center for Medicare and Medicaid Services to evaluate the effectiveness of home-based primary care teams to provide “comprehensive, coordinated, continuous, and accessible care” to patients with multiple chronic illnesses and functional limitations. Mood and anxiety disorders are common problems in homebound older adults, with studies suggesting that approximately 14% of older adults receiving home care meet criteria for major depressive disorder, and as many as 32% meet criteria for an anxiety disorder. Behavioral medicine problems such as obesity, smoking, and chronic pain are also common in this population. Yet older homebound adults in need of mental or behavioral health services typically do not receive adequate treatment. In particular, frail elders receiving home health services seldom receive psychosocial treatment, despite the fact that many patients prefer it, and it may offer advantages over pharmacotherapy for older adults with multiple medical conditions who already take many medications. This symposium will provide an introduction to conducting psychosocial interventions in the home and conducting research in collaboration with community and social service agencies. In the first presentation, Dr. Dimitris Kiosses will describe how to conduct a form of Problem-Solving Therapy in the home with depressed, cognitively impaired older people. His intervention involves caregivers and environmental support and has demonstrated efficacy for both depressive symptoms and disability in homebound older adults. In the second presentation, Dr. Julie Wetherell will describe how to adapt behavioral medicine interventions into this setting based on her work as a psychologist on an interdisciplinary VA home care team. Finally, Dr. Amber Gum will describe how to partner with community service agencies to engage in research efforts to improve in-home mental health services. Faculty Disclosures: Amber M. Gum, PhD Nothing to disclose
Dimitris N. Kiosses, PhD Nothing to disclose Julie Wetherell, PhD Research Support: Forest Laboratories Session 219 EXECUTIVE DYSFUNCTION AND ANTIDEPRESSANT TREATMENT NON-RESPONSE IN LATE-LIFE DEPRESSION: UNDERSTANDING THE NEURAL MECHANISMS OF INTERFERENCE Joel Sneed, PhD1, Sarah S. Morimoto, PsYD2, David Steffens, MD3, George S. Alexopoulos, MD2 1Queens College, Flushing, NY 2Weill Medical College of Cornell University, White Plains, NY 3Duke University Medical Center, Durham, NC Abstract: Deficits in executive functioning, referred to as executive dysfunction, are common in late-life depression and have been associated with poor response to antidepressant treatment and increased rates of relapse and recurrence (G. Alexopoulos et al., 2005; Kalayam & Alexopoulos, 1999; Murphy & Alexopoulos, 2006; Sneed et al., 2007). However, executive dysfunction represents a broad, multifaceted class of functions consisting of mental planning and organization, cognitive flexibility, set development and shifting, and error monitoring (Podell & Lovell, 2000). The present symposium will discuss the concept of executive dysfunction and the neural mechanisms that mediate interference based on data from short-term clinical trials and longitudinal studies. Dr. Morimoto will discuss the relationship between verbal strategy and remission in geriatric depression. She will pay particular attention to the impact of decrements in performance on a semantic fluency task and a verbal episodic memory task on antidepressant response rates. The findings from this study support the concept that executive functioning exerts a “top down” effect on other basic cognitive processes, perhaps as a “downstream” result of frontostriatal network dysfunction implicated in geriatric depression. Dr. Sneed will discuss the construct of executive function and its underlying neurocircuitry as well as a series of findings based on the Old-Old Depression Study, a 12-week placebo-controlled study of citalopram. He will show that executive deficits are not only restricted to antidepressant treatment but interfere with the treatment expectation underlying the placebo effect. Dr. Steffens will discuss the heterogeneity of late-life depression and that one source of this heterogeneity is response to antidepressant treatment. He will focus on the relationship between executive dysfunction and vascular brain changes as seen in neuroimaging studies and how these interact resulting in poor antidepressant treatment response. His presentation will review the complex literature linking executive dysfunction, neuroimaging changes, and treatment response in late-life depression, and discuss findings from several studies in the context of the vascular depression hypothesis. Dr. Alexopoulos (discussant) will bring the various findings and ideas from the these presentations together as well as provide an historical overview of the role and importance of executive dysfunction geriatric depression, including the role of his proposed depression executive dysfunction syndrome, and discuss directions for future research. Faculty Disclosures: George S. Alexopoulos, MD Research Support: Forest Speakers Bureau: Forest, Lilly, BMS, Astra Zeneca, Merck Shareholder: Johnson & Johnson Sarah S. Morimoto, PsYD Nothing to disclose Joel Sneed, PhD Nothing to disclose David Steffens, MD Nothing to disclose Session 220 GERIATRIC MENTAL HEALTH EDUCATION ALONG THE U.S. MEXICO BORDER: CHALLENGES AND OPPORTUNITIES
Jason Schillerstrom, MD1, Paul Kirwin, MD2, Adela Valdez, MD3, Amanda Wright, MD1, Jessica Sandoval, MD1 1UTHSCSA, San Antonio, TX 2Yale, New Haven, CT 3UTHSCSA-RAHC, Harlingen, TX Abstract: In 1998 the University of Texas system established a regional academic health center in the Lower Rio Grande Valley along the U.S. Mexico border. Approximately twenty medical students per year elect to complete all of their third year clinical clerkships in this border region that contains a large Mexican American majority with strong cultural and economic ties to Mexico. This symposium will discuss specific challenges and opportunities related to medical student training in this cross cultural border region. The symposium will begin with a demographic description of the Lower Rio Grande Valley characterized by a rapidly growing elder population with a strong Hispanic heritage. Cultural and socioeconomic challenges for bringing academic medicine to this region will be discussed. Specific challenges include faculty and institutional recruitment, student safety, and the establishment of trust within a community that has long depended on unhindered access to less expensive Mexican physicians and pharmacies for healthcare needs. However, this program will particularly emphasize medical student experiences and perspectives. Recent medical student trainees from this border region will discuss the cross cultural challenges and opportunities they faced while learning from and caring for elders during their clerkships. The audience will learn how this unique setting provides our students with the opportunities to develop cross cultural empathy and understand the socio-cultural impact of untreated mental health that inspires many to pursue careers in psychiatry. Faculty Disclosures: Paul Kirwin, MD Nothing to disclose Jessica Sandoval, MD Nothing to disclose Jason Schillerstrom, MD Other: Texas Adult Protective Services (APS) Research Support: NIH Adela Valdez, MD Nothing to disclose Amanda Wright, MD Nothing to disclose Session 221 LATE LIFE SCHIZOPHRENIA: RECENT ADVANCES John Kasckow, MD, PhD1,2, Carl I. Cohen, MD4, Ipsit Vahia, MD3, Dilip V. Jeste, MD3 1VA Pittsburgh Health Care System, Pittsburgh, PA 2UPMC Western Psychiatric Institute and Clinics, Pittsburgh, PA 3University of California, San Diego, San Diego, CA 4SUNY Downstate Medical Center, New York, NY Abstract: Schizophrenia is a serious illness and one of the most expensive psychiatric disorders. With the aging of the general population at large, over the next several decades we anticipate that the number and proportion of older patients with schizophrenia will increase dramatically. The current research symposium will include presentations by investigators from different sites across the United States. They will cover recent research in this patient population. The topics will range from studies examining longitudinal outcome of depression (Dr. Cohen), augmenting antipsychotics with SSRI's to treat subsyndromal depression (Dr. Vahia) and development of a coping manual in patients with suicidal behavior (Dr. Kasckow). Dr. Dilip Jeste will be the symposium discussant and will relate these findings towards treating this population. Thus, the session will present exciting new advances in this area.
Faculty Disclosures: Carl I. Cohen, MD Nothing to disclose Dilip V. Jeste, MD Other: Astra Zeneca; Bristol Meyers Squibb; Eli Lilly; Janssen John Kasckow, MD, PhD Nothing to disclose Ipsit Vahia, MD Nothing to disclose
Sunday, March 20, 2011 8:00 AM – 9:30 AM Session 302 IMPROVING THE POST-HOSPITAL TRANSITION FOR GERIATRIC INPATIENTS: SPECIAL CONSIDERATIONS FOR COGNITIVE IMPAIRMENT Gary Epstein-Lubow, MD1, Ana Tuya Fulton, MD2 1Alpert Medical School of Brown University, Providence, RI 2Butler Hospital, Providence, RI Abstract: This symposium will review evidence regarding health services projects to improve post-hospital transitions, with specific emphasis on care of the frail elderly with cognitive impairment. Transitions of care, an ongoing area of high clinical and research interest, refers to the actions involved in coordinating care for patients as they move through various settings in the health care system. The clinical goal during a transition is to effectively communicate the treatments most-recently received and the needs for aftercare and beyond. Communication across settings and between practitioners is paramount, as is the patient’s and family’s understanding of the illnesses and clinical requirements for ongoing management. Several post-hospital transition programs have demonstrated reductions in rehospitalization and lower costs for medical patients. The focus of these programs has been the medical discharge and “hand-off” process; interestingly, most studies have excluded individuals with cognitive impairment. It is only recently that tailored aftercare services have focused on comprehension of discharge instructions and other vulnerabilities that individuals with cognitive impairment may have following medical hospitalization. Symposium participants will be provided information regarding recently-published consensus guidelines from the 2007 Transitions of Care Consensus Conference along with examples of prominent multi-state and national-level programming such as the Care Transitions Intervention developed by Eric Coleman at the University of Colorado. Additional examples of program development, successes and pitfalls will be drawn from regional programming in Rhode Island. Though data regarding post-hospital transition programs for individuals with cognitive impairment is relatively sparse, there is evidence to suggest that the vulnerable population of cognitively impaired individuals is a group with heightened need for coordinated aftercare. Perhaps most demonstrative is the psychiatric hospitalization for behavioral disturbance in dementia; this situation requires particularly complex aftercare management in both the home-care and nursing home care settings. Actions to potentially improve the aftercare process following hospitalization for dementia with behavioral disturbance will be discussed. In Rhode Island, Quality Partners of Rhode Island, the Medicare Quality Improvement Organization for RI, was one of 14 states awarded a Medicare contract to expand the National Patient Safety Initiative to include care transitions projects. The interventions focus on the medical patient’s discharge from the hospital. Goals include improving communication across healthcare settings; making systematic changes in hospitals, nursing homes, and home health care agencies to promote more coordinated transitions; and teaching patients to better self-manage their medical conditions, with the ultimate goal of improved clinical outcomes and reduced hospital readmission rates. Participants for this symposium will have the opportunity to discuss how the presented examples might correlate with similar clinical and empirical work in their own region.
Faculty Disclosures: Gary Epstein-Lubow, MD Nothing to disclose Ana Tuya Fulton, MD Nothing to disclose Session 303 A CLINICAL/RESEARCH MODEL FOR PSYCHIATRIC CARE OF LATINO RURAL-DWELLING OLDER PERSONS. Bernardo Ng, MD1, Ipsit Vahia, MD2, Alvaro Camacho, MD2, Daniel E. Jimenez, PhD3 1Sun Valley Behavioral Med Ctr, Impeial, CA 2UCSD, La Jolla, CA 3Dartmouth Medical School, Lebanon, NH Abstract: BACKGROUND: Less than 5% of research on rural-dwelling Latinos addresses mental health care. There is little evidence to guide establishment of rural clinical or research infrastructure in psychiatry, especially in underserved areas along the US-Mexican border region, even though this population is at higher risk for multiple psychiatric illnesses. In this session, we describe the process of establishing a dedicated psychiatry care infrastructure in Imperial County, CA - a rural community that has been designated as a medically underserved area. In 2008 its population was estimated in 160,600 of which 122,124 (76%) were of Latino origin. In 2009, the main city, El Centro, was reported to have highest unemployment rate in the nation. AIMS: Provision of services of Latino seniors in rural communities poses unique challenges. Here, we describe an initiative that has successfully integrated the Imperial County Behavioral Health System, local community clinics which are Federally Qualified Health Centers and a private practice clinic, Sun Valley Behavioral Medical Center (SVBMC). We describe collaboration between this rural clinical initiative with research centers at the University of California at San Diego and Los Angeles, to promote research in this community. We present findings from research projects focusing on rural-dwelling older Latinos conducted in Imperial County. METHODS: SVBMC, founded in 1998, currently serves 110 seniors in its outpatient center. It provides psychiatric evaluations, medication management, individual and family therapy, psycho educational sessions, and a weekly group therapy session in Spanish. Since then, geriatric psychiatry care has grown to include long term facilities (i.e. retirement homes and nursing skill facilities) and Adult Day Healthcare Center. SVBMC is currently piloting the use of telemedicine for rural psychiatric care. RESULTS: Services developed include maintenance physical therapy, social work assessments, family interventions, elder abuse/neglect screenings, case management, TB detection, occupational therapy, music therapy and retraining in activities of daily living. Ongoing research includes 2 NIMH sponsored projects (one of them in the elderly), 10 clinical industry sponsored trials, and a site for field trials of DSM V. Imperial County is also a site for studies on the use of telepsychiatry among rural Latinos, which holds potential to significantly improve access to care for several rural communities at a low cost. Clinical and research activities using the Imperial County model have so far resulted in 13 original papers (10 related to geriatric issues) and 14 abstracts have been accepted to scientific meetings in the US and Latin America of which 5 are related to geriatric issues. DISCUSSION: Imperial County is unique in that it is one of few locations to bulid infrastructure for clinical services and coordination of research projects among rural Latinos. It includes one of the few private clinical centers to serve as a site for NIH funded research projects. It may be the only center dedicated to studies of rural Latino elderly. Finally, our studies using telepsychiatry hold potential to serve as a model for nationwide implementation of telepsychiatry related clinical and collaborative-research projects. While the efforts of SVBMC only cover a minor part of the population in need we believe that this model is worth replicating in other Latino and/or minority underserved communities of seniors across the nation. Faculty Disclosures: Alvaro Camacho, MD Nothing to disclose Daniel E. Jimenez, PhD Nothing to disclose
Bernardo Ng, MD Nothing to disclose Ipsit Vahia, MD Nothing to disclose
10:30 AM – 12:00 PM Session 304 POLICY AND POLITICS: SHAPING MENTAL HEALTH PRIORITIES IN THE 112TH CONGRESS Karen Blank, MD1, Michael Hash, BA2, Amy Walter, BA3 1Institute of Living, Hartford, CT 2White House Office of Health Reform, Washington, DC 3National Journal, Inc, Washington, DC Abstract: This public policy workshop will provide an overview of the current legislative, regulatory and political environment that impacts the development and enactment of health and mental health policy at the Federal level. For the first two years of the Obama Administration, Democrats held large majorities in both the House of Representatives and the Senate, but an almost toxic partisanship made legislative progress extremely difficult. The 2010 elections are not likely to improve that situation but will point up some of the issues that both sides will want to address or emphasize in 2011, both to attain policy goals and to lay the groundwork for the Presidential race in 2012. Perhaps the most challenging policy question for Congress and the Administration will be reaching agreement on how to reduce looming long-term budget deficits. However, under that overarching concern, the 111th Congress is dealing with a domestic agenda dominated by consideration of measures to stimulate the economy, preserve jobs, invest in infrastructure, and protect those who are unemployed. Having enacted major health care reform legislation, much of the attention of the health care community is focused on implementation and the regulations that will govern it. The members and staff of the Congressional committees with health care jurisdiction were exhausted by the protracted negotiations and debate for the health care legislation and may be unwilling to undertake new measures that, in the current environment, could be expected to bring another round of bitter, partisan debate with little chance for success. Nevertheless, there will be pressure from health care advocates for action on a number of issues that were set aside during the debate on health care reform. Foremost among them is the acknowledged but as yet unresolved conundrum on how to avoid deep annual cuts in the Medicare physician fee schedule. Several major health programs are now operating under expired authorization statutes, including the Substance Abuse and Mental Health Administration (SAMHSA), health professions education programs, and the Older Americans Act, which governs programs in the Administration on Aging. Also, the current budget strains have meant substantial cut-backs in funding for existing programs. This public policy session will explore the merging of political action with policy development through analysis of mental health and health care issues and the current political environment. It will enable participants to have an understanding of the legislative and regulatory issues that may be considered at the Federal level in 2011, as well as an understanding of the results of the 2010 Congressional elections and their impact on those issues. Presidential politics for 2012 will also begin to have a bearing. The first part of the session will consist of the political environment that shaped the 2010 Congressional elections and the Speakers will then discuss the political environment for the mid-term Congressional elections and the policy implications as the 112th Congress convenes. The next presentation will address health policy issues that will be on Congress’s agenda and expectations for legislative success. The issues include Medicare reimbursement for physicians’ services; geriatric medical education; legislation setting new policy for both aging and mental health services; and funding for mental health services and research programs. Finally, the session will identify strategies for AAGP and individual geriatric psychiatrists to utilize to ensure that the voice of geriatric psychiatry is heard as these and other health care issues are considered by Congress, the Federal regulatory agencies, and the White House. Faculty Disclosures: Karen Blank, MD Nothing to disclose
Michael Hash, BA Nothing to disclose Amy Walter, BA Nothing to disclose Session 305 MOLECULAR MARKERS IN GERIATRIC MOOD DISORDERS: IMPLICATIONS FOR DIAGNOSIS AND TREATMENT Brent Forester, MD, MSSc1, David G. Harper, PhD1, John E. Jensen, PhD1, Olu Ajilore, MD, PhD2, Anand Kumar, MD2 1McLean Hospital, Belmont, MA 2University of Illinois, Chicago, IL Abstract: This symposium will introduce the advancing technology of MRS and give examples of ongoing clinical studies that aim to identify biomarkers associated with both pathophysiology and treatment response in older adults with depression and bipolar disorder. Dr. Eric Jensen, an MRS physicist who collaborates with psychiatric clinicians, will discuss advantages and disadvantages of different MRS techniques and the potential of MRS in neuropsychiatric research. Dr. Brent Forester will present data from an 8 week open-label study of lamotrigine, a presynaptic glutamate antagonist, in older adults with bipolar depression. This study examines the relationship between clinical response to treatment and markers of energy metabolism including lactate, glutamate, glutamine and NAA. Dr. Olu Ajilore will discuss proton MRS findings from a study exploring the relationship between geriatric depression and diabetes. Findings suggest that alterations in glutamate and glutamine in subcortical regions along with white matter changes in myo-inositol provide important neurobiological substrates of mood disorders. Dr. David Harper will present data from a study of older individuals with Major Depression using phosphorus MRS at 4 Tesla. Study findings demonstrate that elevated membrane breakdown products, glycerophosphoethanolamine (GPEtn) and glycerophosphocholine (GPCho), suggest greater white matter neurodegeneration in late-life depression. Dr. Kumar will serve as a discussant for the potential role of MRS in contributing to the understanding of the pathophysiology and treatment of geriatric mood disorders. Faculty Disclosures: Olu Ajilore, MD, PhD Nothing to disclose Brent Forester, MD, MSSc Research Support: NIMH; NARSAD Speakers Bureau: Eli Lilly; Astra Zeneca; Novartis Research Support: Rogers Family Foundation; GlaxoSmithKline David G. Harper, PhD Nothing to disclose John E. Jensen, PhD Nothing to disclose Anand Kumar, MD Other: AAGP - Associate Editor of the AJGP Speakers Bureau: CME Outfitters Session 306 VARIOUS CONTEXTS FOR CAREGIVER SUPPORT: AN EVIDENCE-BASED APPROACH TO THE FAMILY AND THE CARING ENVIRONMENT Gary J. Kennedy, MD1, Linda Teri, PhD2, Sharon Lewis, RN, PhD, FAAN3, Denise Miner-Williams, RN, PhD, CHPN3, Lyda C. Arevalo-Flechas, RN, PhD3
1Montefiore Medical Center, Bronx, NY, NY 2University of Washington School of Nursing, Seattle, WA 3University of Texas Health Science Center at San Antonio, San Antonio, TX Abstract: The taxing responsibilities and the stress of complex caregiving place family caregivers at risk for emotional, mental, and physical health problems. The value that family caregivers provide to our society is being recognized by the health policy community but health care provider training and public policy remain far behind. A deeper understanding of the caregiving experience can enable health care providers to gain insight into the caregivers’ world and enable them to better sustain caregivers in their role. This symposium explores various contexts for caregiver support including assisted living facility and community - based programs. The development and effectiveness of a multimodal Stress-Busting Program for Family Caregivers of patients with Alzheimer's disease and Parkinson's disease will be presented. Caregivers who participated in the Stress-Busting Program demonstrated significant improvement in their quality of life and well-being, decreased responsiveness to stressors, and reduced depression. The challenges of adapting and disseminating this program to other caregiver populations and settings will be discussed. In addition, the moderating role of language and culture in the perception of the caregiving experience will be explored. When family caregivers are reluctant to care for themselves or seek help, health care professionals should assist them in getting the support that they need. Faculty Disclosures: Lyda C. Arevalo-Flechas, RN, PhD Nothing to disclose Gary J. Kennedy, MD Nothing to disclose Sharon Lewis, RN, PhD, FAAN Nothing to disclose Denise Miner-Williams, RN, PhD, CHPN Nothing to disclose Linda Teri, PhD Nothing to disclose Session 307 SELECTED TOPICS IN DELIRIUM: MANAGING SPECIFIC CLINICAL PROBLEMS Barbara Kamholz, MD1, Yesne Alici, MD1, David J. Loreck, MD2 1Duke University, Durham, NC 2University of Maryland, Baltimore, MD Abstract: This symposium will cover three important but rarely discussed topics in the clinical management of delirium. First, delirium is easily confused with delirium tremens particularly when the history of substance abuse is vague or unknown. It can also be quite difficult to distinguish from hypomania/mania. Second, The prevalence of delirium among those elderly patients admitted to emergency rooms, particularly among those arriving from institutional settings, is not widely known, yet the implications of "missed delirium" are increasingly understood to be dire. This symposium will review ways to improve diagnosis and to manage delirium in this setting. Third, a concise review of practical strategies to address and manage delirium in the inpatient setting will be provided that summarizes the content of recent work in the field as well as that of the National VA Delirium Working Group. Faculty Disclosures: Yesne Alici, MD Nothing to disclose Barbara Kamholz, MD Nothing to disclose
David J. Loreck, MD Nothing to disclose Session 308 TELEMEDICINE IN HOME-BASED CARE Dimitris N. Kiosses, PhD1, Namkee G. Choi, PhD3, Thomas Sheeran, PhD2, Martha L. Bruce, PhD, MPH1 1Weill Cornell Medical College, White Plains, NY 2Rhode Island Hospital/Brown Medical School, Providence, SC 3University of Texas, Austin, TX Abstract: Homebound older adults suffer high rates of major depression (>14%) with more than 25% reporting clinically significant depressive symptoms. The number of homebound seniors is large and expected to double in the next decade: this year over 6 million older adults receive home-based long term care from family and/or professional care givers. Medicare provided acute home healthcare to 5 million older adults (a group partially overlapping with long term care). Despite this significant need for depression treatment, homebound depressed elders have difficulty accessing mental health services. As technology advances, tele-medicine may offer an alternative way to provide depression treatment. This symposium will focus on the latest developments of tele-medicine in the provision of depression management and treatment to homebound older adults. Dr. Kiosses, from Weill Cornell Medical College, will provide an overview of tele-medicine in home-based mental health care, highlighting the advantages and the challenges as well as identifying areas for future research, especially in home-bound older adults with depression and significant cognitive impairment. Dr. Choi, from University of Texas, Austin, will describe telehealth Problem Solving Therapy (PST), where PST is provided through teleconference to homebound older adults. Despite the efficacy of in-person PST in the treatment of geriatric depression, many homebound older adults do not have access to PST. Dr. Choi will present preliminary data on her study testing telehealth PST vs. in-person PST and attention control (telephone care calls) in this population. Dr. Sheeran, from Rhode Island Hospital and The Warren Alpert Medical School of Brown University, will discuss his research, which utilizes homecare’s existing telehealth disease management infrastructure to provide centralized, evidence-based care management for geriatric depression. He will present preliminary findings from a pilot study conducted with three home health agencies in New York, Florida and Vermont, and will discuss potential benefits and challenges of using telemedicine to implement a depression care management program in homecare. Dr. Bruce, of Weill Cornell Medical College, will serve as the chair and the discussant and will place this research in the context of the existing home-based care system. Faculty Disclosures: Martha L. Bruce, PhD, MPH Consultant: Medispin, Inc Namkee G. Choi, PhD Nothing to disclose Dimitris N. Kiosses, PhD Nothing to disclose Thomas Sheeran, PhD Nothing to disclose Session 309 FROM THE BEDROOM TO THE COURT ROOM: THE ABILITY OF PATIENTS WITH DEMENTIA TO CONSENT TO SEX James G. Bouknight, MD, PhD, Shilpa Srinivasan, MD, Jamae Campbell, MD University of South Carolina School of Medicine, Columbia, SC Abstract: With older adults living longer and healthier lives, sexuality plays an important role in personal and clinical setting. The notion of older adults as sexual beings has sometimes been denied, regarded with humor or even distaste, conflicting with younger individuals’ stereotypes of parents or grandparents. The advent of the sexual revolutions of the
1960s and 1970s, combined with the coming of age of the baby-boomer generation, and wide-spread use of treatments for sexual dysfunction has led to broader perspectives on sexuality in late-life. Sexuality continues to be an important part of many individuals with dementia. However the severity of dementing illness may hinder initiation or sustenance of sexual performance, and behavioral disturbance in dementia may be associated with inappropriate or sexually aggressive behaviors. Especially when individuals transition from community-dwelling or assisted living settings to long-term care facilities, staff and caregiver attitudes towards sexuality play an important part. In addition, the ability to consent to sexual relationships in an individual with dementia, or a partner with dementia, needs to be elucidated. Litigation in this area is often feared, but few facilities have formal policies or staff education to guide this process. Faculty Disclosures: James G. Bouknight, MD, PhD Nothing to disclose Jamae Campbell, MD Nothing to disclose Shilpa Srinivasan, MD Nothing to disclose
2:30 PM – 4:00 PM Session 311 THE POINT OF VIEW OF OLDER ADULTS: USING MIXED METHODS IN MENTAL HEALTH SERVICES RESEARCH Joseph J. Gallo, MD, MPH1, Ladson Hinton, MD2, Judith C. Barker, PhD3, Jürgen Unützer, MD4, Marsha Wittink, MD MBE1 1University of Pennsylvania, Philadelphia, PA 2UC Davis School of Medicine, Sacramento, CA 3UCSF, San Francisco, CA 4University of Washington, Seattle, WA Abstract: Our research on mental health has motivated us to mix methods because interventions developed through traditional research paradigms have not had the hoped-for public health impact and there is a need for new social and behavioral science approaches to mental health interventions. In most clinical research, the biomedical model guides the questions and methods employed (etic or external scientific explanations) including strategies that may have been developed for groups other than the groups to which they are applied. In contrast, obtaining the insider perspective seeks to understand the patient’s point of view (the emic frame), employing methods that are designed to elicit the patient’s preferences and values. Speakers in this symposium will discuss research employing mixed methods, drawing on both quantitative and qualitative methods to understand how older adults view suicide and the components of depression services that would engage them in treatment. Two approaches to conjoint methods, which allow study of the influence of specific service features on preferences, will be presented. Discussants will put the work in the context of recent developments in mixed methods, public health, and community-based research, discussing the challenges and opportunities in mixing methods for mental health services research. Faculty Disclosures: Judith C. Barker, PhD Nothing to disclose Joseph J. Gallo, MD, MPH Nothing to disclose Ladson Hinton, MD Nothing to disclose Jürgen Unützer, MD Nothing to disclose
Marsha Wittink, MD MBE Nothing to disclose Session 312 EXPLORING THE NEUROTROPHIC HYPOTHESIS: BDNF GENETIC VARIATION IN LATE-LIFE DEPRESSION Warren D. Taylor, MD, MHS1, Francis E. Lotrich, MD, PhD3, Faith Gunning-Dixon, PhD2, Lihong Wang, MD, PhD1 1Duke University Medical Center, Durham, NC 2Weill Cornell Medical College, White Plains, NY 3University of Pittsburgh, Pittsburgh, PA Abstract: In the last decade there has been development of the Neurotrophic Hypothesis of Depression. This theory posits that altered function and expression of neurotrophic factors may contribute to risk of depression. Moreover, antidepressant effect may be ultimately mediated by increasing the expression of neurotrophic factors. Brain-derived neurotrophic factor (BDNF) appears to play an important role in these relationships potentially due to its influence as a regulator of synaptic plasticity. Although this theory has informed research in animal models and younger adult populations, it has not been thoroughly investigated in older individuals. This is crucial as older individuals may be particularly vulnerable to depression in context of altered BDNF function or expression. BDNF expression is increased with physical activity, and conversely may be reduced in cases of medical infirmity or disability where physical activity is less. Moreover, aging itself is associated with reduced BDNF expression in frontal brain regions. Such effects may influence risk of depression or antidepressant response in elderly individuals. This symposium will focus on recent work in late-life depression examining polymorphisms in the BDNF gene. We will begin with a brief overview of the Neurotrophic Hypothesis and what role BDNF may play in depression and response to antidepressants. We will then discuss recent research examining the relationship between BDNF genetic variation and clinical variables, response to antidepressants, and both structural and functional MRI findings associated with depression. Faculty Disclosures: Faith Gunning-Dixon, PhD Nothing to disclose Francis E. Lotrich, MD, PhD Nothing to disclose Warren D. Taylor, MD, MHS Nothing to disclose Lihong Wang, MD, PhD Nothing to disclose Session 313 GERIATRIC PSYCHIATRY PARTNERSHIPS WITH ADULT PROTECTIVE SERVICES (APS): OPPORTUNITIES FOR CLINICAL AND RESEARCH COLLABORATIONS Jason Schillerstrom, MD1, Jo Ann Tobias-Molina, MA2, Donald R. Royall, MD1 1UTHSCSA, San Antonio, TX 2Texas Adult Protective Services - Region 8, San Antonio, TX Abstract: Each year 45,000 case of neglect, exploitation, or abuse are confirmed by Texas Adult Protective Services (APS). During investigations APS specialists must consider the decisional capacity of their clients when determining which least restrictive services to offer. However, a physician’s medical opinion must be rendered in cases where physical or mental conditions such as dementia preclude one’s ability to attend to self-care needs. Texas APS Region 8, which covers 22 counties from the Gulf Coast to the U.S. Mexico border, has contracted with The University of Texas Health Science Center at San Antonio (UTHSCSA) to provide in-home decision making capacity consultations across South
Texas. This multidisciplinary workshop will discuss the specific challenges APS faces as they strive to protect elders from neglect, exploitation, and abuse and how the medical community, particularly geriatric psychiatric specialists, can fill a crucial societal role when determining safe and least restrictive disposition. During the past three years UTHSCSA geriatric psychiatrists have conducted approximately 250 in-home decision making capacity assessments. The methodology used for determining who has decisional capacity and who is safe to remain at home will be discussed. Published findings and new research describing the sample referred for decisional assessments and demonstrating the key sociodemographic and neuropsychological predictors of self-care abilities, including squalor dwelling status, will be presented (1). Research opportunities for understanding hoarding behaviors, the restoration of decisional capacity, and self awareness as it relates to physical needs will be discussed. It is our hope that this symposium inspires geriatric psychiatrists to develop their own partnerships with APS in an effort to eliminate neglect, exploitation, and abuse of the vulnerable population we serve. Reference 1. Schillerstrom JE, Salazar R, Regwan H, Bonugli RJ, Royall DR. Executive function in self-neglecting adult protective services referrals compared to elder psychiatric outpatients. American Journal of Geriatric Psychiatry. 2009 Oct;17(10):907-910. Faculty Disclosures: Donald R. Royall, MD Nothing to disclose Jason Schillerstrom, MD Other: Texas Adult Protective Services (APS) Research Support: NIH Jo Ann Tobias-Molina, MA Nothing to disclose Session 314 ADVANCES IN THE UNDERSTANDING OF COGNITIVE AND MENTAL HEALTH IN POSTMENOPAUSAL WOMEN: EMERGING FINDINGS FROM THE WOMEN’S HEALTH INITIATIVE STUDIES Susan M. Resnick, PhD1, Sylvia Wassertheil-Smoller, PhD2, Joseph S. Goveas, MD3, Regina Shih, PhD4 1National Institute on Aging, National Institutes of Health, Baltimore, MD 2Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY 3Medical College of Wisconsin, Milwaukee, WI 4RAND, Associate Behavioral/Social Scientist, Arlington, VA Abstract: The Women's Health Initiative (WHI) is a long-term national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer and osteoporotic fractures in postmenopausal women. The WHI Observational Study (WHI-OS) is a long-term prospective cohort study to identify and assess the impact of biological, lifestyle, biochemical, and genetic factors for the risk of heart disease, cancer, osteoporosis, and other major health problems of older women. The WHI randomized controlled trials of hormone therapy (WHI-HT) assessed the risks and the benefits of hormone therapy (conjugated equine estrogens with medroxyprogesterone acetate (E+P) or E-Alone) relative to placebo in healthy postmenopausal women. The WHI-HT study examined the effects of combined hormones or estrogen alone on the prevention of coronary heart disease and osteoporotic fractures, and associated risk for breast cancer. WHIMS E+P and E-Alone trials began in 1996 and ended in 2002 and 2004, respectively, when WHI-HT were terminated after individuals in the treatment arms showed an excess risk of unfavorable outcomes, including stroke and embolic events, and lack of overall benefit. The Women’s Health Initiative Memory Study (WHIMS), an ancillary study to the WHI-HT, was the largest longitudinal study designed to examine the role of postmenopausal HT on cognitive function in women aged 65 years and older. The primary objective was to examine whether postmenopausal HT reduced the risk of all-cause dementia and, secondarily, mild cognitive impairment (MCI), and whether it influenced global cognitive functioning in healthy women age 65-79 (mean 69) years at WHIMS baseline. WHIMS found that HT substantially increased the risk of dementia and MCI relative to placebo. The WHIMS-MRI study was designed to examine the possible mechanisms by which HT detrimentally affected cognition in WHIMS. WHIMS-MRI reported that the women who were assigned to HT had greater atrophy in the frontal lobe and hippocampus, but no significant increase in ischemic lesion brain volumes.
WHIMS post-trial cognitive assessment is conducted annually. In addition, depressive symptoms were assessed during baseline in WHI studies. This AAGP session will highlight emerging findings from the WHI studies on the association of cognitive health with HT; association of depression and antidepressant use with incident cognitive decline and cardiovascular morbidity and mortality; and relationship between neighborhood socioeconomic status and cognitive function. The individual abstracts are developed based on data from the Women’s Health Initiative (WHI-OS, WHI-HT, WHIMS and WHIMS-MRI) studies. Faculty Disclosures: Joseph S. Goveas, MD Nothing to disclose Susan M. Resnick, PhD Nothing to disclose Regina Shih, PhD Nothing to disclose Sylvia Wassertheil-Smoller, PhD Nothing to disclose Session 315 DISASTER PREPAREDNESS: HOW DO NURSING HOMES PREPARE AND WHAT SHOULD PROVIDERS AND TRAINEES BE TAUGHT? Maria D. Llorente, MD1, Shilpa Srinivasan, MD2, Kathryn Hyer, PhD3 1Miami VAMC, Miami, FL 2University of South Carolina, Columbia, SC 3University of South Florida, Tampa, FL Abstract: Older adults, particularly frail elderly, are at increased risk for adverse consequences associated with disasters. Facilitating emergency preparedness may mitigate some of these consequences. Nursing home facility administrators face unique challenges in preparing for emergencies and/or disasters, including: deciding whether to evacuate, arranging for appropriate transportation, addressing resource issues following the event. Similarly, geriatric mental health providers may be unfamiliar with what they can effectively do to facilitate disaster preparedeness among their elderly patients. Lastly, the logistics of successful evacuations, including the characteristics of special needs shelters should be incorporated into preparedness plans, but providers are often unfamiliar with the necessary factors that should be considered. These issues can be addressed through the review of existing successful models in both Florida and Texas. Additionally, the education and training of physicians and healthcare providers caring for older adults with mental illness should include disaster psychiatry as it applies to the geriatric population. This session will include proposed training materials and educational resources for geriatric mental health and medicine educators. Faculty Disclosures: Kathryn Hyer, PhD Nothing to disclose Maria D. Llorente, MD Nothing to disclose Shilpa Srinivasan, MD Nothing to disclose Session 316 UNDERSTANDING MODELS OF DISABILITY AND REHABILITATION: MAXIMIZING FUNCTIONAL INDEPENDENCE Jordan F. Karp, MD1, Elizabeth Skidmore, PhD, OTR/L1, Scott W. Shaffer, PT, PhD, OCS, ECS, LTC, SP 2, Ellen M. Whyte, MD1
1University of Pittsburgh, Pittsburgh, PA 2Baylor University, San Antonio, TX Abstract: Whether examining the associations between depression and cognitive function, depression and activities of daily living, or depression and societal participation, the geriatric psychiatrist wrestles with these complex associations on a daily basis. Dr. Skidmore will provide an overview of current models of disability, with a particular focus on the World Health Organization’s International Classification of Functioning, Disability and Health (2001). Her presentation will apply these current models of disability to geriatric psychiatry, using relevant clinical case scenarios to illustrate how one may use these models to comprehensively address disability in clinical practice and research. Dr. Karp will provide a focused review of pivotal papers from the late-life depression and disability literature, especially as it relates to the effects of low back pain and arthritis and physical functioning in older adults. Dr. Whyte will describe how depression negatively affects successful rehabilitation after a debilitating medical event, such as a stroke or hip fracture. She will describe the multifactorial mechanisms through which depression may be negatively influencing rehabilitation outcomes which may include the influence of depression-related impairments in motivation, motor speed, and cognitive function on the process of both recovery from and adaptation to physical impairments. She will discuss the extent to which successful treatment of depression improves outcomes of stroke rehabilitation and review recent evidence suggesting that antidepressants may have a pro-recovery effect independent of their effect on mood. Dr. Schaeffer will describe the association between falls in late-life and disability. His presentation will illustrate how physical activity can reduce fall risk and the progression of disability in older adults. Dr. Schaeffer will discuss the current evidence and practical application of clinical examination items employed for effective fall risk and disability screening for older adults. Specifically, his presentation will utilize case studies and video demonstration of simple strength, balance and physical performance examination items to reinforce and enhance learning. The psychometric properties of examination items for the general population of older adults, as well as older adults with high risk health conditions (e.g. stroke, diabetes, polyneuropathy) will also be discussed. Faculty Disclosures: Jordan F. Karp, MD Research Support: Eli Lilly Shareholder: Corcept Consultant: Eli Lilly; Theravance Other: Novartis Scott W. Shaffer, PT, PhD, OCS, ECS, LTC, SP Nothing to disclose Elizabeth Skidmore, PhD, OTR/L Nothing to disclose Ellen M. Whyte, MD Research Support: Forest Pharmaceuticals; FoxLearning Systems; NICHD/NCRRR; Pfizer Pharmaceuticals; Eli Lilly
4:15 PM – 5:45 PM Session 317 PAIN, PALLIATIVE CARE AND END OF LIFE ISSUES IN PSYCHOGERIATRIC PATIENTS: RECENT ADVANCES Jothika Manepalli, MD1, George T. Grossberg, MD1, Veerainder Goli, MD2 1Saint Louis University Medical Center, Saint Louis, MO 2Duke University Medical Center, Durham, NC Abstract: Prevalence of pain is high in the elderly. Several illness such as arthritis, post stroke pain, post herpetic neuralgia, naturopathic pain, cancer, radiation and chemotherapy cause severe and persistent pain in the elderly. By 2030, it is estimated that more than 70% of cancers will occur in the geriatric population. Increasing the need for appropriate and effective pain and palliative care. Depression, anxiety dementia and delirium complicate pain by modifying the perception of pain and interfering with the ability to express pain. Research shows that Pain is exacerbated when there are three or more coexisting diseases. Acute and chronic pain cause loss of independent functioning and compromise
effective treatment of co morbid medical disorders and can worsen or cause depression, insomnia and poor nutrition, which may affect the survival of the patient. Any report of pain should be taken seriously. Pain control is an essential part of palliative care. A comprehensive approach is needed and should be multidimensional addressing physical, psychological, social, interpersonal and spiritual needs of both patients and their families. It is also essential to address and treat anxiety and depression at any stage of the terminal illness and in patients with advanced dementia. Advance directives, assessing for capacity and other legal issues can be complicated and should be addressed. The primary objective of palliative care should be to improve the quality of life and meaning of life and death. Faculty Disclosures: Veerainder Goli, MD Other: Employed by King Pharmaceuticals George T. Grossberg, MD Nothing to disclose Jothika Manepalli, MD Nothing to disclose Session 318 SENIOR HOUSING AND TWO BILLION OLDER ADULTS: ADAPTING HOMES FOR 'AGING IN PLACE' AND DESIGNING OPTIMAL COMMERCIAL RESIDENTIAL ENVIRONMENTS FOR OLDER PERSONS WITH PHYSICAL AND COGNITIVE IMPAIRMENTS Zorica M. Ljaljevic, MD1, Daniel D. Sewell, MD2, Paula Carder, PhD3, Margaret Calkins, PhD, CAPS, EDAC4, Stephen F. Winner, MS5 1Zorica M. Ljaljevic/ Dr. Zorica, Los Altos, CA 2University of California San Diego / UCSD, San Diego, CA 3Institute on Aging and Community Health at Portland State University, Portland, OR 4Innovative Designs in Environments for an Aging Society, Inc/ I.D.E.A.S., Inc., Kirtland, OH 5Silverado Senior Living, Belmont, CA Abstract: Increasing numbers of frail and cognitively impaired older persons who would have placed in a nursing home instead reside in community-based forms of senior housing. This symposium will provide definitions of purpose-built senior housing such as assisted living and residential care, specialized dementia units, and adult foster care in the U.S. An overview of resident characteristics and facility characteristics ( e.g. staffing requirements, physical design) based on national surveys will be provided. Models of care based on evidence-based facility design and organizational process will be presented. Shared residential settings for elders is moving from the traditional institutional, staff-centric model to an approach that embraces the rights of all individuals to make decisions about the daily life and focuses on meaningful relationships - with family, friends and staff. There is a growing body of research that supports the benefits of these approaches in clinical, psycho-social and financial terms. Creating a " Living Environment" that provides great care and great quality of life with dementia that requires less medication,manages and prevents inappropriate behavior will be discussed. Age and cultural considerations, use of children and pets in daily programs and interactions will be presented. Faculty Disclosures: Margaret Calkins, PhD, CAPS, EDAC Nothing to disclose Paula Carder, PhD Nothing to disclose Zorica M. Ljaljevic, MD Nothing to disclose Daniel D. Sewell, MD
Shareholder: Traveling Educational Presentations, Inc Grant funding: The John A. Hartford Foundation; National Institute of Mental Health Other: The Healthcare Group Inc; Lippincott Williams & Wilkins; The American Geriatrics Society Stephen F. Winner, MS Nothing to disclose Session 319 LEWY BODY DISEASE: THE UNDISCOVERED COUNTRY Donald R. Royall, MD1, Jeffrey A. Cordes, MD2 1UTHSCSA, San Antonio, TX 2Audie L. Murphy Memorial Veterans Administration Hospital, San Antonio, TX Abstract: Lewy Body Disease (LBD) is thought to be the second most common cause of neurodegenerative dementia, after Alzheimer’s Disease (AD). Autopsy studies suggest that 20-30% of dementia cases may have clinically significant LBD pathology. Much of this pathology is found co-morbidly with AD lesions, making the clinical differentiation of these disorders difficult. However, the true clinical burden of LBD may be much more complicated. This symposium will survey recent studies on LBD and illustrate their significance with clinical vignettes: LBD pathology may begin outside the Central Nervous System (CNS) and can be associated with pre-clinical autonomic dysfunction in multiple organs. LBD appears to invade the brain through the vagus nerve. Cardiac imaging may best distinguish LBD from AD. A sizable fraction of “vascular cognitive impairment” may be attributable to LBD instead. Only a fraction of cases with cardiac involvement exhibit clinical parkinsonism and visual hallucinations. Late onset depression and psychosis may also represent manifestations of LBD. REM sleep behavioral disorder may represent an early stage in LBD’s development. Common geriatric syndromes (falls, syncope, incontinence, chronic constipation, delirium, sundowning) may specifically reflect the presence of extracranial LBD lesions. Faculty Disclosures: Jeffrey A. Cordes, MD Nothing to disclose Donald R. Royall MD Nothing to disclose
MONDAY, MARCH 21, 2011 9:15 AM – 10:45 AM Session 401 ADVANCES IN UNDERSTANDING COGNITIVE AND EMOTIONAL DISORDERS OF AGING THROUGH BRAIN IMAGING Paul Newhouse, MD1, Susan M. Resnick, PhD4, Howard Aizenstein, MD, PhD2, Julie Dumas, PhD1, Faith Gunning-Dixon, PhD3 1University of Vermont, Burlington, VT 2University of Pittsburgh, Pittsburgh, PA 3Weil Cornell Medical College, New York, NY 4National Institute on Aging, Baltimore, MD Abstract: While brain imaging has become a standard tool in many aspects of medicine, structural and/or functional imaging of the brain has been underutilized in geriatric psychiatry. However, significant advances have been made in developing correlates of brain structure and activity not only with normal aging but also with clinical entities common to late life patients. Advances in structural MRI, functional MRI, and PET imaging have significantly advanced the ability
to understand the etiopathogenesis of late life mental disorders but have also begun to be used for diagnosis, tracking of illness, and treatment outcome. Novel approaches such as combining neuropharmacologic techniques with functional brain imaging methods, combining cognitive measures with structural imaging to develop models of cognitive decline, and analyses of network activity within the brain have brought this technology to the threshold for use in clinical diagnosis and treatment in geriatric psychiatry. The symposium will feature leading imaging scientists who focus on problems of brain aging and psychopathology. New research on the specific application of advanced imaging techniques to the problems of geriatric psychiatry will be emphasized. The focus will be specifically regarding cognitive disorders of aging and emotional disorders such as depression. Data will be presented illustrating how best to use advanced imaging techniques for both understanding the mechanisms of geriatric mental disorders as well as the potential for using these techniques in diagnosis and treatment planning. Susan Resnick, PhD (NIA) will discuss her research on using brain imaging to develop predictors of cognitive decline in normal aging. Howard Aizenstein, MD, PhD (University of Pittsburgh) will present new research on utilizing neuroimaging to understand the mechanisms of geriatric depression through analysis of functional connectivity of brain circuitry. Julie Dumas, PhD (University of Vermont) will present new data on utilizing pharmacologic models and brain imaging to model cognitive aging. Faith Gunning-Dixon, PhD (Cornell University) will present new work examining how using brain imaging to analyze brain network activity may be helpful in understanding treatment response in geriatric depression. Paul Newhouse, MD (University of Vermont) will act as chair and discuss and contextualize these results within an understanding of the clinical challenges of geriatric psychiatry. Faculty Disclosures: Howard Aizenstein, MD, PhD Research Support: Novartis Pharmaceuticals - Support is for a study unrelated to what I will be discussing. The work I will be discussing is solely from NIH supported research. Julie Dumas, PhD Nothing to disclose Faith Gunning-Dixon, PhD Nothing to disclose Paul Newhouse, MD Nothing to disclose Susan M. Resnick, PhD Nothing to disclose Session 402 ELECTROCONVULSIVE THERAPY IN THE ELDERLY: NEW RESEARCH FOR CLINICAL PRACTICE William M. McDonald, MD1, Charles H. Kellner, MD3, Georgios Petrides, MD4, Robert M. Greenberg, MD2 1Emory University Medical School, Atlanta, GA 2UMDNJ, Hoboken, NJ 3Mount Sinai School of Medicine, New York, NY 4Zucker Hillside Hospital, New York, NY Abstract: Robert Greenberg, MD (Medical Director, Geropsychiatry and ECT Services at Hoboken University Medical Center and Associate Professor of Psychiatry at UMDNJ): Overview of ECT in the elderly including the state of data for the elderly, when ECT should be considered, response rates (including response rates related to age and concommitant symptoms such as psychosis) and relapse rates. William McDonald, MD (J.B. Fuqua Professor in the Department of Psychiatry and Behavioral Sciences and Chief of the Division of Geriatric Psychiatry at Emory University Medical): The administration of ECT in the elderly including the effect of age on seizure threshold, anesthetic use in the elderly, special considerations for post ictal recovery and cognitive monitoring. The use of ultrabrief ECT in the elderly will also be discussed. Charles Kellner, MD (Professor of Psychiatry and Director of the Division of Geriatric Psychiatry at the Mount sinai School of Medicine): The importance of electrode placement on both response and side effects will be reviewed
including new data comparing unilateral, bitemporal and bifrontal ECT will be reviewed. Some preliminary data on the efficacy of these electrode placements in the elderly will be reviewed. Georgios Petrides (Associate Professor of Psychiatry at the Albert Einstein College of Medicine and Director of ECT Research at the Zucker Hillside Hospital): Dr. Petrides will give an overview of the use of maintenance pharmacotherapy and maintenance ECT in the elderly. Faculty Disclosures: Robert M. Greenberg, MD Nothing to disclose Charles H. Kellner, MD Research Support: NIMH - research grant William M. McDonald, MD Research Support: Wyeth Pharmaceuticals; Glaxo Smith Kline; Neuronetics; Boehinger Ingelheim; Janssen Speakers Bureau: Janssen Georgios Petrides, MD Nothing to disclose Session 403 EATING DISORDERS IN THE ELDERLY Maria I. Lapid, MD1, Donald E. McAlpine, MD1, Kathryn J. Zerbe, MD2, Teresa A. Rummans, MD1 1Mayo Clinic, Rochester, MN 2Oregon Health & Science University, Portland, OR Abstract: While typically a disorder of young adults, eating disorders do occur in the elderly and often with significant morbidity and mortality. However, eating disorders are frequently overlooked in the elderly, especially in the context of multiple medical comorbidities that confound the clinical picture. Literature on eating disorders in the elderly is limited. This session will review the existing literature on eating disorders in the elderly and discuss the knowledge gaps in this area. Dr. Rummans will serve as the moderator. Dr. Lapid will present a literature review. Dr. McAlpine will explore differences in the evaluation and management of eating disorders between geriatric and nongeriatric individuals. Dr. Zerbe will discuss the psychodynamic aspects, which are crucial in understanding eating disorders in the elderly. Faculty Disclosures: Maria I. Lapid, MD Nothing to disclose Donald E. McAlpine, MD Nothing to disclose Teresa A. Rummans, MD Nothing to disclose Kathryn J. Zerbe, MD Nothing to disclose Session 404 PSYCHOSOCIAL INTERVENTIONS FOR DEPRESSED ELDERS WITH CO-OCCURRING COGNITIVE IMPAIRMENT AND DISABILITY Dimitris N. Kiosses, PhD1, Patricia A. Arean, PhD2, Patrick Raue, PhD1, George S. Alexopoulos, MD1 1Weill Cornell Medical College, White Plains, NY 2University of California in San Francisco, San Francisco, CA
Abstract: Depression, cognitive impairment, and disability often co-exist in the elderly and have a complex relationship. Depression may promote disability while at the same time disability may be a risk factor for depression. The relationship of depression and disability becomes even more complicated in the presence of cognitive impairment, as depression contributes to cognitive impairment and cognitive impairment is associated with significant disability. As a result, to effectively treat depression psychosocial interventions may target not only depression but also disability. Further, they may incorporate strategies to bypass the behavioral and functional limitations due to cognitive impairment. This symposium will focus on the latest psychosocial interventions for depressed elders with co-occurring disability and cognitive impairment. Dr. Patricia Arean will present an overview of psychosocial interventions in this population and data on the effects of Problem Solving Therapy (PST) in reducing depression and disability in homebound older adults. The first study, from the Senior Behavioral Health Study, investigated the use of PST for treating depression in older adults with MDD who were living in residential care. All PST participants (N=20) had significant reduction in depression symptoms. In the second study, fifty older adults receiving home based nursing services were treated with either clinical management or PST with clinical management. Those who received PST with clinical management were less depressed and had better functional outcomes at post-treatment than those who received clinical management only. Dr. Dimitris Kiosses will discuss Problem Adaptation Therapy (PATH), a new home-delivered intervention for homebound depressed elders with advanced cognitive impairment. PATH utilizes a personalized approach focusing on the patient’s ecosystem (i.e. the patient, the caregiver, and the home-environment) and targeting behavioral problems related not only to depression but also to disability and cognitive impairment. Dr. Kiosses will present pilot data testing 12 weeks of PATH vs. home-delivered Supportive Therapy. Preliminary data demonstrated participants in PATH had significant greater reductions in depression and disability than participants in Supportive Therapy at the end of treatment. Dr. Patrick Raue will present a collaborative study between Weill Cornell Advanced Center for Interventions and Services Research (ACISR) (PI: Alexopoulos) and University of California in San Francisco (PI: Arean). In this study, 200 low-income older adults, living in impoverished neighborhoods, and receiving home based meals, are randomized to receive PST with case management and case management alone. Primary outcome measures are depression and disability at post-treatment and six months after treatment completion. The interventionists are community based clinical social workers employed in the home-based meals program. Dr. George Alexopoulos will serve as the chair and the discussant and will place this research in the context of the existing psychosocial interventions in geriatric depression and propose future directions to effectively treat this population. Faculty Disclosures: George S. Alexopoulos, MD Research Support: Forest Speakers Bureau: Forest, Lilly, BMS, Astra Zeneca, Merck Shareholder: Johnson & Johnson Patricia A. Arean, PhD Nothing to disclose Dimitris N. Kiosses, PhD Nothing to disclose Patrick Raue, PhD Nothing to disclose
11:00 AM – 12:30 PM Session 405 WHAT'S FAMILY GOT TO DO WITH IT? THE ROLE AND INFLUENCE OF FAMILY AND NON-KIN IN DEPRESSION CARE FOR OLDER ADULTS Ladson Hinton, MD1, Jürgen Unützer, MD, MPH, MA2, E. Carolina Apesoa-Varano, PhD1, Jennifer L. Wolff, PhD3 1U.C. Davis Medical Center, Sacramento, CA 2University of Washington, Seattle, WA 3Johns Hopkins University, Baltimore, MD
Abstract: The role of family and non-kin in depression care processes among older adults is often noted but has received surprising little systematic attention in primary care focused mental health services and clinical research. Family may be an important "untapped resource" that can be mobilized to improve the quality and accessibility of care for older adults in primary care who are suffering from clinical depression. Our panel addresses this gap in the field, bringing together four richly complementary perspectives on the relationship of informal social networks and depression care. The first presentation, based on analysis of audiotaped primary care encounters linked to patient surveys, will focus on whether older adults’ physical and mental health status is influential in regard to (1) rates of accompaniment, and (2) communication dynamics of accompanied and unaccompanied primary care physician visits. The second presentation, based on analysis of problem-solving therapy sessions conducted as part of IMPACT, will focus on the importance of family issues as a focus of treatment in depressed older adults. The final two presentations are based on analysis of data from the Men's Health and Aging Study, a project focused on improving depression care for older Mexican American and white non-Hispanic men in primary care settings. The third presentation is based on analysis of qualitative data and focuses on the perspectives of primary care physicians on family involvement as a “double-edged sword” in the care of depressed older men. The final presentation is based on qualitative interviews with older men and illuminates older men's attitudes, both positive and negative, towards involvement family participation in their ongoing depression treatment in primary care. Faculty Disclosures: E. Carolina Apesoa-Varano, PhD Nothing to disclose Ladson Hinton, MD Nothing to disclose Jürgen Unützer, MD, MPH, MA Nothing to disclose Jennifer L. Wolff, PhD Nothing to disclose Session 406 NEUROMODULATION THERAPIES IN THE ELDERLY: CAN THE NEW THERAPIES REPLACE ECT FOR RESISTANT DEPRESSION IN THE ELDERLY? William M. McDonald, MD1, Charles H. Kellner, MD3, Paul E. Holtzheimer, MD1 1Emory University Medical School, Atlanta, GA 2University of Texas, Southwestern, Dallas, TX 3Mount Sinai, New York, NY Abstract: William McDonald, MD (J.B. Fuqua Professor in the Department of Psychiatry and Behavioral Sciences and Chief of the Division of Geriatric Psychiatry at Emory University Medical): Dr. McDonald will review results from the NIMH sponsored Optimization of Transcranial Magnetic Stimulation (OPT-TMS) trial and outline how these results can apply to the elderly. Dr. McDonald will review the data on the response of TMS in the elderly and provide potential methods to increase the response to TMS in older adults. Paul Holtzheimer, MD (Assistant Professor of Psychiatry and Behavioral Sciences and Investigator in the Emory Deep Brain Stimulation Program): Deep Brain Stimulation (DBS) studies in younger patients have shown considerable promise for the treatment of pharmacoresistant depression. The use of DBS in older adults with treatment resistant depressed (TRD) has been limited primarily because of safety concerns with the surgery in older adults. Dr. Holtzheimer will review the potential benefits of DBS and include new data from the younger cohort treated with DBS at Emory. Dr. Holtzheimer will include a discussion of the safety of DBS in elderly patients with Parkinson's disease and how these studies could be applied to older adults with TRD. Charles Kellner, MD (Professor of Psychiatry and Director of the Division of Geriatric Psychiatry at the Mount sinai School of Medicine): Dr. Kellner will review the role of ECT in neuromodulation therapies. ECT is the gold standard for treatment resistant depression in the elderly. Dr. Kellner is the President of the International Society of the Neuromodulation and he will discuss the role of convulsive therapy in the treatment of pharmacoresistant depression and the potential for nonconvulsive therapies in depression therapy.
Faculty Disclosures: Paul E. Holtzheimer, MD Consultant: St. Jude Medical Neuromodulation Charles H. Kellner, MD Research Support: NIMH William M. McDonald, MD Research Support: Wyeth Pharmaceuticals; Glaxo Smith Kline; Neuronetics; Boehinger Ingelheim; Janssen Speakers Bureau: Janssen Session 407 TRANSLATIONAL RESEARCH ON AGING AND ANXIETY DISORDERS: MULTIPLE AVENUES George Niederehe, PhD1, Francis S. Lee, MD, PhD2, Amit Etkin, MD, PhD3, Melinda A. Stanley, PhD4, M. Katherine Shear, MD5 1NIMH, Bethesda, MD 2Weill Medical College of Cornell University, New York, NY 3Stanford University, Stanford, CA 4Baylor College of Medicine, Houston, TX 5Columbia University, New York, NY Abstract: Over recent years, there have been major advances in scientific understanding of the neurocircuitry of fear reactions, the neurobiology of the formation and extinction of fearful memories, and the like, but little research has been directed at translating such findings into new clinical applications for alleviating anxiety disorders in older adults. This symposium will discuss several lines of cutting-edge, translational research that have major potential for reshaping the understanding and treatment of anxiety disorders in later life. Dr. Lee will describe a series of studies in both mice and humans on the role of neurotrophic factors in anxiety, particularly brain derived neurotrophic factor (BDNF). This work sheds light on potential genetic influences, and highlights early neurodevelopmental transitions that may have important implications for the experience of anxiety later in life. Dr. Etkin will discuss several brain imaging investigations of emotion-related circuitry and emotion regulation, translating basic science work in animal models to humans, and contrast the respective neuroimaging biosignatures of anxiety and depressive disorders. He will outline the relation that the aging process may have to these phenotypes, and opportunities that knowledge of these biosignatures opens for treatment. Dr. Stanley will describe a translational research process that focuses on expanding the reach for anxiety treatments in older adults, particularly cognitive-behavioral therapy (CBT), to primary medical care settings, where the majority of older adults with anxiety disorders seek care, and to rural and community settings, where need is high and available services are limited. The discussant, Dr. Shear, will reflect on the promise inherent in these and similar lines of research, on their relationship to other trends in the field (such as interest in developing transdiagnostic approaches to anxiety disorder treatment), and on the challenges to be faced in developing a more robust translational science of anxiety disorders and aging. The symposium will close with a period devoted to interactive audience participation. Faculty Disclosures: Amit Etkin, MD, PhD Consultant: NeoStim Francis S. Lee, MD, PhD Nothing to disclose George Niederehe, PhD Nothing to disclose M. Katherine Shear, MD Nothing to disclose Melinda A. Stanley, PhD Nothing to disclose
Session 408 UNDERSTANDING ETHICAL AND LEGAL DILEMMAS IN GERIATRIC PSYCHIATRY - A PRACTICAL APPROACH FOR TRAINERS AND TRAINEES Shuja Haque, MD,MRCPsych1, Tatyana P. Shteinlukht, MD,PhD2, Sherif Soliman, MD3, Paul Kirwin, MD4 1Wayne State University School of Medicine, Detroit, MI 2University of Massachusetts Medical School, Boston, MA 3Case Western Reserve University School of Medicine, Cleveland, OH 4Yale University School of Medicine, New Haven, CT Abstract: Ethical and legal dilemmas are commonly encountered during the practice of geriatric psychiatry. Despite the importance of ethics most physicians do not receive any formal training in medical ethics. Similarly systematic training in legal issues relevant to the care of the elderly maybe limited to a few didactic lectures. Most medical centers in the United States rely on ethics consultants and attorneys to address ethical issues that arise during clinical practice. While input from non-psychiatrist ethics consultants and lawyers can be valuable, the availability of geriatric psychiatrists who possess expertise in medical ethics and forensic psychiatry can be invaluable. The University of Massachusetts Medical School provides trainees a unique educational experience in the shape of a monthly seminar that addresses legal aspects related to medical ethics and conflicts in patient care. Ethics consultation is a widely accepted healthcare service in the United States. Recently a major study of ethics consultation in United States hospitals, reported that the majority of individuals who perform ethics consultations in the United States health systems, are clinicians especially physicians and nurses. This study also reported that 41% of individuals who perform ethics consultations had learned to perform ethics consultations with formal direct supervision by an experienced member of an Ethics consultation service and only one in 20 had completed a graduate degree program in bioethics. The Accreditation Council for Graduate Medical Education in the United States mandates ethics education in the training of resident physicians. However the manner in which this education is obtained, is left upto the individual training programs. The Wayne State University fellowship program in Geriatric Psychiatry in conjunction with the John Dingell VA in Detroit has included geriatric psychiatry fellows as part of their ethics consultation teams. As trainee-members of ethics consult teams, residents gain hands-on experience in ethics consultation under supervision of experienced ethics consultants. We believe training in ethics consultation and more hands-on training in forensic psychiatry, will enhance the knowledge and skills of trainee psychiatrists in medical ethics and laws relating to medical practice, and increase their competence as geriatric psychiatry practitioners in an increasingly complex practice environment. Faculty Disclosures: Shuja Haque, MD, MRCPsych Nothing to disclose Paul Kirwin, MD Nothing to disclose Tatyana P. Shteinlukht, MD, PhD Nothing to disclose Sherif Soliman, MD Nothing to disclose
Alphabetical List of Presenters at Educational Sessions Marc E. Agronin, MD Practical Approaches to Psychotherapy with Older Adults Howard Aizenstein, MD, PhD Advances in Understanding Cognitive and Emotional Disorders of Aging through Brain Imaging Olu Ajilore, MD, PhD Molecular Markers in Geriatric Mood Disorders: Implications for Diagnosis and Treatment George S. Alexopoulos, MD Executive Dysfunction and Antidepressant Treatment Non-Response In Late-Life Depression: Understanding The Neural Mechanisms of
Interference Psychosocial Interventions for Depressed Elders with Co-occurring Cognitive Impairment and Disability Yesne Alici, MD Selected Topics in Delirium: Managing Specific Clinical Problems Allan A. Anderson, MD Is There a Future for Geriatric Psychiatry? Presidential Address: Meeting the Challenges in Geriatric Mental Health: Directing our Future E. Carolina Apesoa-Varano, PhD What's Family Got to Do with It? The Role and Influence of Family and Non-kin in Depression Care for Older Adults Maria Aranda, PhD Innovations in Mental Health Interventions for Older Latinos Patricia A. Arean, PhD Innovations in Mental Health Interventions for Older Latinos Practical Approaches to Psychotherapy with Older Adults Psychosocial Interventions for Depressed Elders with Co-occurring Cognitive Impairment and Disability Lyda C. Arevalo-Flechas, PhD, RN Various Contexts for Caregiver Support: An Evidence-Based Approach to the Family and the Caring Environment Muhammad Aslam, MD Maintenance of Certification and the Performance in Practice Component: Sample Tools for the Care of Patients with Depression. Clive Ballard, MD Emerging from Between a Rock and a Hard Place: Treating the Neuropsychiatric Symptoms of Dementia Judith C. Barker, PhD The Point of View of Older Adults: Using Mixed Methods in Mental Health Services Research Stephen Bartels, MD, MS Geriatric Mental Health Services Research: A Discussion for Early Career Investigators How Can We Get Research Findings Into Practice? Results from Three National Programs on Implementing Evidence-Based Practices for
Geriatric Depression
Karen Blank, MD Policy and Politics: Shaping Mental Health Priorities in the 112th Congress Frederic C. Blow, PhD Geriatric Mental Health Services Research: A Discussion for Early Career Investigators
Anne Borjesson-Hanson, MD, PhD U.S. and International Models of Mental Health Outreach Care for the Elderly James G. Bouknight, MD, PhD From the Bedroom to the Court Room: The Ability of Patients with Dementia to Consent to Sex Lisa Boyle, MD The New Frontier: Moving Geriatric Psychiatry Fellowship Training into Community Interdisciplinary Settings Elizabeth J. Bragg, PhD, RN Is There a Future for Geriatric Psychiatry? Charlotte Brown, PhD Disparities in Mental Health Services: Moving from Description to Interventions Martha L. Bruce, PhD, MPH Geriatric Mental Health Services Research: A Discussion for Early Career Investigators How Can We Get Research Findings Into Practice? Results from Three National Programs on Implementing Evidence-Based Practices for
Geriatric Depression Telemedicine in Home-Based Care
Meryl A. Butters, PhD The Early Identification of Alzheimer Disease Margaret Calkins, PhD, CAPS, EDAC Senior Housing and Two Billion Older Adults: Adapting Homes for 'Aging in Place' and Designing Optimal Commercial Residential
Environments for Older Persons with Physical and Cognitive Impairments Alvaro Camacho, MD A Clinical/Research Model for Psychiatric Care of Latino Rural-Dwelling Older Persons. Jamae Campbell, MD From the Bedroom to the Court Room: The Ability of Patients with Dementia to Consent to Sex Paula Carder, PhD Senior Housing and Two Billion Older Adults: Adapting Homes for 'Aging in Place' and Designing Optimal Commercial Residential
Environments for Older Persons with Physical and Cognitive Impairments David Casey, MD Powers of Attorney, Guardianships, and Advance Directives in Geriatric Psychiatry Josepha A. Cheong, MD Is There a Future for Geriatric Psychiatry? Namkee Choi, PhD Telemedicine in Home-Based Care Cheryl Claassen, PhD Gay and Gray II: Addressing the Mental Health Care Needs of Older Lesbian, Gay, Bisexual, and Transgendered Individuals Juan Carlos Cleves-Bayon, MD Baby Boomers and Substance Abuse: Recognition, Assessment and Evidence-Based Treatment in the Clinical Setting Carl I. Cohen, MD Late Life Schizophrenia: Recent Advances
Christopher C. Colenda, MD, MPH Maintenance of Certification and the Performance in Practice Component: Sample Tools for the Care of Patients with Depression. Jeffrey Cordes, MD Lewy Body Disease: The Undiscovered Country Bernadette Cullen, MB, BCh BAO MRCPsych U.S. and International Models of Mental Health Outreach Care for the Elderly Julie Dumas, PhD Advances in Understanding Cognitive and Emotional Disorders of Aging through Brain Imaging Gary Epstein-Lubow, MD Improving the Post-Hospital Transition for Geriatric Inpatients: Special Considerations for Cognitive Impairment Randall Espinoza, MD, MPH Educating the Next Generation of Physicians in Geriatric Psychiatry Amit Etkin, MD, PhD Translational Research on Aging and Anxiety Disorders: Multiple Avenues Jovier D. Evans, PhD Psychopharmacology and Older Adults: Safety, Risk, and Opportunities Marianne E. Felice, MD Successful Mentoring: Does Gender Matter? Brent Forester, MD, MSSc Molecular Markers in Geriatric Mood Disorders: Implications for Diagnosis and Treatment Ana Tuya Fulton, MD Improving the Post-Hospital Transition for Geriatric Inpatients: Special Considerations for Cognitive Impairment Joseph J. Gallo, MD, MPH Disparities in Mental Health Services: Moving from Description to Interventions The Point of View of Older Adults: Using Mixed Methods in Mental Health Services Research Laura Gitlin, PhD Emerging from Between a Rock and a Hard Place: Treating the Neuropsychiatric Symptoms of Dementia Veerainder Goli, MD Pain, Palliative Care and End of Life Issues in Psychogeriatric Patients: Recent Advances. Joseph Goveas, MD Advances in the Understanding of Cognitive and Mental Health in Postmenopausal Women: Emerging Findings from the Women’s Health
Initiative Studies
Robert M. Greenberg, MD Electroconvulsive Therapy in the Elderly: New Research for Clinical Practice David Greenspan, MD, FAPA E&M Coding and Documentation: A Workshop George T. Grossberg, MD Pain, Palliative Care and End of Life Issues in Psychogeriatric Patients: Recent Advances.
Amber M. Gum, PhD Where the Heart Is: Behavioral Interventions in Home Care Faith Gunning-Dixon, PhD Advances in Understanding Cognitive and Emotional Disorders of Aging through Brain Imaging Exploring the Neurotrophic Hypothesis: BDNF Genetic Variation in Late-Life Depression Ellen Haller, MD Gay and Gray II: Addressing the Mental Health Care Needs of Older Lesbian, Gay, Bisexual, and Transgendered Individuals Shuja Haque, MD, MRCPsych Understanding Ethical and Legal Dilemmas in Geriatric Psychiatry - A Practical Approach for Trainers and Trainees Ashley Harmon, MD The New Frontier: Moving Geriatric Psychiatry Fellowship Training into Community Interdisciplinary Settings David G. Harper, PhD Molecular Markers in Geriatric Mood Disorders: Implications for Diagnosis and Treatment Michael Hash, MA Policy and Politics: Shaping Mental Health Priorities in the 112th Congress Ladson Hinton, MD Innovations in Mental Health Interventions for Older Latinos The Point of View of Older Adults: Using Mixed Methods in Mental Health Services Research What's Family Got to Do with It? The Role and Influence of Family and Non-kin in Depression Care for Older Adults Paul E. Holtzheimer, MD Neuromodulation Therapies in the Elderly: Can the New Therapies replace ECT for resistant depression in the elderly? Steven Huege, MD The New Frontier: Moving Geriatric Psychiatry Fellowship Training into Community Interdisciplinary Settings Kathryn Hyer, PhD Disaster Preparedness: How Do Nursing Homes Prepare and What Should Providers and Trainees be Taught? Clifford R. Jack, MD The Early Identification of Alzheimer Disease Jeanne Jackson-Siegal, MD Getting Started in Practice: How to Do it Right or Mistakes Not to Make. Lissy Jarvik, MD, PhD Educating the Next Generation of Physicians in Geriatric Psychiatry John E. Jensen, PhD Molecular Markers in Geriatric Mood Disorders: Implications for Diagnosis and Treatment Dilip V. Jeste, MD Late Life Schizophrenia: Recent Advances Daniel Jimenez, PhD A Clinical/Research Model for Psychiatric Care of Latino Rural-Dwelling Older Persons. Deirdre Johnston, MB BCh BAO MRCPsych U.S. and International Models of Mental Health Outreach Care for the Elderly
Jin Hui Joo, MD Disparities in Mental Health Services: Moving from Description to Interventions Leon Kagan, MD, FRCPC U.S. and International Models of Mental Health Outreach Care for the Elderly Helen Kales, MD Emerging from Between a Rock and a Hard Place: Treating the Neuropsychiatric Symptoms of Dementia Psychopharmacology and Older Adults: Safety, Risk, and Opportunities Barbara Kamholz, MD Selected Topics in Delirium: Managing Specific Clinical Problems Successful Mentoring: Does Gender Matter? Jordan F. Karp, MD Gay and Gray II: Addressing the Mental Health Care Needs of Older Lesbian, Gay, Bisexual, and Transgendered Individuals Understanding Models of Disability and Rehabilitation: Maximizing Functional Independence John Kasckow, MD, PhD Late Life Schizophrenia: Recent Advances Aaron H. Kaufman, MD Educating the Next Generation of Physicians in Geriatric Psychiatry Charles H. Kellner, MD Electroconvulsive Therapy in the Elderly: New Research for Clinical Practice Neuromodulation Therapies in the Elderly: Can the New Therapies replace ECT for resistant depression in the elderly? Gary J. Kennedy, MD Providing Psychiatric Services for Hard to Serve Populations: How to Reach Holocaust Survivors in the Community Various Contexts for Caregiver Support: An Evidence-Based Approach to the Family and the Caring Environment Dimitris N. Kiosses, PhD Psychosocial Interventions for Depressed Elders with Co-occurring Cognitive Impairment and Disability Telemedicine in Home-Based Care Where the Heart Is: Behavioral Interventions in Home Care Paul Kirwin, MD Baby Boomers and Substance Abuse: Recognition, Assessment and Evidence-Based Treatment in the Clinical Setting Geriatric Mental Health Education Along the U.S. Mexico Border: Challenges and Opportunities Understanding Ethical and Legal Dilemmas in Geriatric Psychiatry - A Practical Approach for Trainers and Trainees Elihu Kover, MSW Providing Psychiatric Services for Hard to Serve Populations: How to Reach Holocaust Survivors in the Community Anand Kumar Molecular Markers in Geriatric Mood Disorders: Implications for Diagnosis and Treatment Helen H. Kyomen, MD, MS Powers of Attorney, Guardianships, and Advance Directives in Geriatric Psychiatry Melinda S. Lantz, MD Maintenance of Certification and the Performance in Practice Component: Sample Tools for the Care of Patients with Depression. Maria I. Lapid, MD Eating Disorders in the Elderly
Brian Lawlor, MD FRCPsych U.S. and International Models of Mental Health Outreach Care for the Elderly Francis S. Lee, MD, PhD Translational Research on Aging and Anxiety Disorders: Multiple Avenues Monica S. Lewis, PhD The New Frontier: Moving Geriatric Psychiatry Fellowship Training into Community Interdisciplinary Settings Sharon Lewis, PhD, RN, FAAN Various Contexts for Caregiver Support: An Evidence-Based Approach to the Family and the Caring Environment Lance Lichtor, MD Successful Mentoring: Does Gender Matter? Zorica Ljaljevic, MD Senior Housing and Two Billion Older Adults: Adapting Homes for 'Aging in Place' and Designing Optimal Commercial Residential
Environments for Older Persons with Physical and Cognitive Impairments
Maria Llorente, MD Disaster Preparedness: How Do Nursing Homes Prepare and What Should Providers and Trainees be Taught? David J. Loreck, MD Selected Topics in Delirium: Managing Specific Clinical Problems Francis Lotrich, MD, PhD Exploring the Neurotrophic Hypothesis: BDNF Genetic Variation in Late-Life Depression Constantine Lyketsos, MD Emerging from Between a Rock and a Hard Place: Treating the Neuropsychiatric Symptoms of Dementia Is There a Future for Geriatric Psychiatry? David Mamo, MD Psychopharmacology and Older Adults: Safety, Risk, and Opportunities Jothika Manepalli, MD Pain, Palliative Care and End of Life Issues in Psychogeriatric Patients: Recent Advances. Laura Marsh, MD New Research in Psychiatric Symptoms in Parkinson's Disease and Applications for Clinical Practice Donald McAlpine, MD Eating Disorders in the Elderly William McDonald, MD Electroconvulsive Therapy in the Elderly: New Research for Clinical Practice Neuromodulation Therapies in the Elderly: Can the New Therapies replace ECT for resistant depression in the elderly? New Research in Psychiatric Symptoms in Parkinson's Disease and Applications for Clinical Practice Denise Miner-Williams, RN, PhD, CHPN Various Contexts for Caregiver Support: An Evidence-Based Approach to the Family and the Caring Environment Sarah S. Morimoto, PsYD Executive Dysfunction and Antidepressant Treatment Non-Response In Late-Life Depression: Understanding The Neural Mechanisms of
Maureen C. Nash, MD, MS Incorporating Measurement and Scales into Clinical Practice Paul Newhouse, MD Advances in Understanding Cognitive and Emotional Disorders of Aging through Brain Imaging Bernardo Ng, MD A Clinical/Research Model for Psychiatric Care of Latino Rural-Dwelling Older Persons. George Niederehe, PhD Translational Research on Aging and Anxiety Disorders: Multiple Avenues Amita R. Patel, MD Incorporating Measurement and Scales into Clinical Practice Georgios Petrides, MD Electroconvulsive Therapy in the Elderly: New Research for Clinical Practice Annelle B. Primm, MD, MPH Disparities in Mental Health Services: Moving from Description to Interventions Patrick Raue, PhD Psychosocial Interventions for Depressed Elders with Co-occurring Cognitive Impairment and Disability Stephen Read, MD Educating the Next Generation of Physicians in Geriatric Psychiatry Susan M. Resnick, PhD Advances in Understanding Cognitive and Emotional Disorders of Aging through Brain Imaging Advances in the Understanding of Cognitive and Mental Health in Postmenopausal Women: Emerging Findings from the Women’s Health
Initiative Studies
Robert P. Roca, MD, MPH, MBA Powers of Attorney, Guardianships, and Advance Directives in Geriatric Psychiatry Donald R. Royall, MD Geriatric Psychiatry Partnerships with Adult Protective Services (APS): Opportunities for Clinical and Research Collaborations Lewy Body Disease: The Undiscovered Country Teresa A. Rummans, MD Eating Disorders in the Elderly Jessica Sandoval, MD Geriatric Mental Health Education Along the U.S. Mexico Border: Challenges and Opportunities Alessandra Scalmati, MD, PhD Providing Psychiatric Services for Hard to Serve Populations: How to Reach Holocaust Survivors in the Community Jason Schillerstrom, MD Geriatric Mental Health Education Along the U.S. Mexico Border: Challenges and Opportunities Geriatric Psychiatry Partnerships with Adult Protective Services (APS): Opportunities for Clinical and Research Collaborations Winsor Schmidt JD, LLM Powers of Attorney, Guardianships, and Advance Directives in Geriatric Psychiatry
Ken Schwartz, MD, FRCPC Practical Approaches to Psychotherapy with Older Adults Daniel D. Sewell, MD Gay and Gray II: Addressing the Mental Health Care Needs of Older Lesbian, Gay, Bisexual, and Transgendered Individuals Maintenance of Certification and the Performance in Practice Component: Sample Tools for the Care of Patients with Depression Senior Housing and Two Billion Older Adults: Adapting Homes for 'Aging in Place' and Designing Optimal Commercial Residential
Environments for Older Persons with Physical and Cognitive Impairments
Scott Shaffer, PT, PhD, OCS, ECS, LTC, SP Understanding Models of Disability and Rehabilitation: Maximizing Functional Independence M. Katherine Shear, MD Translational Research on Aging and Anxiety Disorders: Multiple Avenues Thomas Sheeran, PhD Telemedicine in Home-Based Care Bryan Shelby, MD Baby Boomers and Substance Abuse: Recognition, Assessment and Evidence-Based Treatment in the Clinical Setting Regina Shih, PhD Advances in the Understanding of Cognitive and Mental Health in Postmenopausal Women: Emerging Findings from the Women’s Health
Initiative Studies
Tatyana P. Shteinlukht, MD, PhD Successful Mentoring: Does Gender Matter? Understanding Ethical and Legal Dilemmas in Geriatric Psychiatry - A Practical Approach for Trainers and Trainees Alan Siegal, MD Getting Started in Practice: How to Do it Right or Mistakes Not to Make. Elizabeth Skidmore Understanding Models of Disability and Rehabilitation: Maximizing Functional Independence Joel Sneed, PhD Executive Dysfunction and Antidepressant Treatment Non-Response In Late-Life Depression: Understanding The Neural Mechanisms of
Interference
Mark Snowden, MD, MPH How Can We Get Research Findings Into Practice? Results from Three National Programs on Implementing Evidence-Based Practices for
Geriatric Depression
Sherif Soliman, MD Understanding Ethical and Legal Dilemmas in Geriatric Psychiatry - A Practical Approach for Trainers and Trainees Shilpa Srinivasan, MD Disaster Preparedness: How Do Nursing Homes Prepare and What Should Providers and Trainees be Taught? From the Bedroom to the Court Room: The Ability of Patients with Dementia to Consent to Sex Melinda A. Stanley, PhD Translational Research on Aging and Anxiety Disorders: Multiple Avenues David Steffens, MD Executive Dysfunction and Antidepressant Treatment Non-Response In Late-Life Depression: Understanding The Neural Mechanisms of
Robert A. Sweet, MD The Early Identification of Alzheimer Disease Warren Taylor, MD, MHS Exploring the Neurotrophic Hypothesis: BDNF Genetic Variation in Late-Life Depression Linda Teri, PhD Various Contexts for Caregiver Support: An Evidence-Based Approach to the Family and the Caring Environment Jo Ann Tobias-Molina, MA Geriatric Psychiatry Partnerships with Adult Protective Services (APS): Opportunities for Clinical and Research Collaborations Louis Trevisan, MD Baby Boomers and Substance Abuse: Recognition, Assessment and Evidence-Based Treatment in the Clinical Setting Jürgen Unützer, MD, MPH, MA Geriatric Mental Health Services Research: A Discussion for Early Career Investigators How Can We Get Research Findings Into Practice? Results from Three National Programs on Implementing Evidence-Based Practices for
Geriatric Depression The Point of View of Older Adults: Using Mixed Methods in Mental Health Services Research What's Family Got to Do with It? The Role and Influence of Family and Non-kin in Depression Care for Older Adults
Frederick W. Unverzagt, PhD The Early Identification of Alzheimer Disease Ipsit Vahia, MD A Clinical/Research Model for Psychiatric Care of Latino Rural-Dwelling Older Persons. Late Life Schizophrenia: Recent Advances Adela Valdez, MD Geriatric Mental Health Education Along the U.S. Mexico Border: Challenges and Opportunities Amy Walter, BA Policy and Politics: Shaping Mental Health Priorities in the 112th Congress Lihong Wang, MD, PhD Exploring the Neurotrophic Hypothesis: BDNF Genetic Variation in Late-Life Depression Earlise C. Ward, PhD Disparities in Mental Health Services: Moving from Description to Interventions Sylvia Wassertheil-Smoller, PhD Advances in the Understanding of Cognitive and Mental Health in Postmenopausal Women: Emerging Findings from the Women’s Health
Initiative Studies
Daniel Weintraub, MD New Research in Psychiatric Symptoms in Parkinson's Disease and Applications for Clinical Practice Psychopharmacology and Older Adults: Safety, Risk, and Opportunities Julie Wetherell, PhD Where the Heart Is: Behavioral Interventions in Home Care Ellen M. Whyte, MD Understanding Models of Disability and Rehabilitation: Maximizing Functional Independence
Stephen F. Winner, MS Senior Housing and Two Billion Older Adults: Adapting Homes for 'Aging in Place' and Designing Optimal Commercial Residential
Environments for Older Persons with Physical and Cognitive Impairments Marsha Wittink, MD MBE The Point of View of Older Adults: Using Mixed Methods in Mental Health Services Research Jennifer L. Wolff, PhD What's Family Got to Do with It? The Role and Influence of Family and Non-kin in Depression Care for Older Adults Amanda Wright, MD Geriatric Mental Health Education Along the U.S. Mexico Border: Challenges and Opportunities Kathryn J. Zerbe, MD Eating Disorders in the Elderly Kara Zivin, PhD Psychopharmacology and Older Adults: Safety, Risk, and Opportunities
