Asynchronous Consultations in Geriatric Psychiatry: Experiences in a Rural Academic Health System

Abstract

More Americans are living longer and entering old age than ever before. The number of adults age 65 years and older in the United States (US) is projected to grow to more than 83.7 million by 2050. Today's 65-year-olds can expect to live, on average, another 19.4 years. However, the outcomes of extending longevity have not kept pace with the US healthcare system's ability to improve mental and cognitive well-being. The 2012 Institute of Medicine (IOM) report estimates that 14%–20% of the elderly population is afflicted by a mental health or substance use condition, including dementia-related behavioral and psychiatric symptoms. Despite this clear growing demographic need, the number of physicians formally trained in geriatric psychiatry and geriatric medicine is shrinking, limiting the availability of specialty care to this vulnerable demographic. This disparity is magnified in rural settings and/or historically disadvantaged areas/populations where access to geriatric psychiatrists and geriatric medicine specialists may be severely limited, if available at all.This session will cover the development, implementation, and preliminary outcome measures of two asynchronous geriatric psychiatry consultation programs, one EMR based e-consultation program and one on-demand telephone consultation program, that have been developed by geriatric psychiatrists at Dartmouth-Hitchcock Medical Center. Our aim is to demonstrate how similar asynchronous geriatric psychiatry consultation programs could be feasibly implemented at essentially any site or within any health system to begin to address the limited availability of specialty geriatric psychiatry expertise, especially in rural and/or historically disadvantaged areas/populations.