Transcript ' Ascent, Descent, Consent: Experiences with Elder Care'

Collaborative Mental Health
Care: Meeting the Accessibility
Needs of Older Adults with
Concurrent Chronic Disorders
CCSMH Conference, September 2007
There are no apparent conflicts of interest that may have a
direct bearing on the subject matter of this presentation
Presenters
 Salinda
Horgan, Ph.D.
 Martha Donnelly, MD, CCFP, FRCP
 Ken LeClair, MD, FRCP
Collaborative Care

Delivery of service by two or more stakeholders
(including consumers)
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Working together in a partnership characterized by
– Common goals or purpose
– Recognition and respect for strengths and
differences
– Equitable and effective decision making
– Clear and regular communication

To improve access to a comprehensive range of
services delivered by the right person, in the right place
at the right time.
Kates, N
Canadian Collaborative Mental
Health Initiative
Framework for Collaborative
Mental Health Care
Members of the Seniors Working Group
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Ken Le Clair, MD, FRCPC – Kingston
Martha Donnelly, MD, CCFP, FRCPC Vancouver
Geri Hinton, B.Sc.N, DStJ – Victoria
Sarah Kreiger-Frost, RN, MN - Halifax
Penny McCourt, MSW, Ph.D. - Nanaimo
Salinda Horgan, Ph.D. – Kingston
Seniors Population Definition
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Age greater than 65, avg. age 75 (exceptions organic
mental disorders).
All psychiatric disorders but with emphasis on:
– Dementia with affective and behavioural disorders
– Mental health problems associated with medical illness
– Complex B/P/S/F/E problems
– Families of seniors with mental health problems
Loss of independent functioning in IADLs/ADLs.
Often present first to family physician with physical
complaints.
Require comprehensive geriatric assessments.
The Consultation Process – What
Multi-disciplinary Working Group
 Literature Review
 Qualitative Interviews
 Quantitative Survey

The Consultation Process - Who
Qualitative interviews:
 6 interviews with family members/consumers.
 7 interviews with services specific to seniors (specialty
psycho-geriatric programs, generic mental health programs,
primary care clinic, adult day program).
 7 interviews with professional disciplines (family doctors,
pharmacy, nursing, social work, cultural development,
research).
 2 interviews with policy advisors.
Quantitative survey:
26 surveys of specialty and generic mental health programs
and policy advisors.
Presentations at conferences
Literature Review – Key Learnings
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On-site primary care and specialty case manager
strategies provide better outcomes for seniors than
traditional care (particularly for those experiencing
mood disorders).
Consultation with liaison provide better outcomes
for seniors than consultation only.
Approaches embedded in a knowledge transfer
framework (evidence based guidelines) provide
better collaboration between diverse partners.
What do we Need to Know About
Seniors?
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Seniors experience the stigma associated
with advanced age and mental health needs
both in the community and within the health
system itself.
Many seniors are experiencing mental health
issues for the first time.
Many family caregivers are seniors
themselves with complex needs.
Accessibility to Collaborative Mental
Health Care

Accessibility is the primordial issue
affecting the degree to which older adults
with complex mental and physical health
issues benefit from collaborative care
Personal Factors

Physical Access
• Attend health care appointments.
• Driving / financial implications.
• Affects number of appointments attended.
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Resource Awareness
• Limited mobility / life-style changes in retirement.
• Limited knowledge of external resources.
• Affects their knowledge of available services.
Caregiver Factors

Complex Coordination
• Coordination of multiple services (special
transit, attendant) for one visit.

Caregiver Health
• Less likely to attend regular check-ups.
• Increased health needs – stress induced.
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Caregiver Inclusion
• Crucial resource (historical contextual
knowledge, communication).
Systemic Factors

Broad Stakeholder Inclusion
• Broad spectrum of health and community partners
needed to address complex health and social
issues.
• Socially diverse population.
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System Fragmentation
• Health conditions are not static (age / functioning).
• System – each developmental stage brings new
services, new providers and new service locations.
Planning Strategies
Think About:
• Location of services.
• Co-location with services / supports relevant to older
adults.
• Seeing older adults in their homes.
• Mutual caregiver/patient appointments.
• Actively involve caregivers in health appointments.
• Collaborate with broad range of stakeholders (health,
family, community).
• Minimizing service fragmentation.
The Health Care Reality
It is estimated that between the years
2020 and 2030, 75% of health providers' time
will be spent with older people
Seller, et al. Gerontology and Geriatrics Education, Vol. 8 3/4, 1988
Seniors Toolkit
www.ccmhi.ca