CogTeach: Teaching Residents to Communicate with Older Patients Who Have Mild Neurocognitive Disorder

Abstract

Introduction: Woodgreen is a large community social services provider in Toronto, Canada delivering a range of services from supportive housing to counselling. Geriatric psychiatry services as delivered in the formal health care system can be difficult to access for marginalized populations. A model of integrated geriatric mental health care was developed with Woodgreen to allow for staff education, clinics delivered at the Woodgreen offices, and home visits. Methods: We describe a year’s experience in developing and delivering an integrated geriatric mental health model of care. A qualitative approach was taken to describe staff and patient experience, and a quantitative approach used to describe the patient population served. Results: Careful stepwise engagement with staff and the community was essential in gaining trust and enabling a close working relationship with case managers and front-line workers who had not previously worked with geriatric psychiatry or who had negative experiences with the formal health care system. Qualitative data indicate significant staff appreciation for ongoing education and support and for relatively rapid access to geriatric psychiatry consultation, quantitative data indicate that the patient population served simply would not have received geriatric psychiatry care otherwise. The program was also helpful in facilitating access of socially isolated elders with complex psychiatric and medical problems to the health care system. Conclusions: Embedding a geriatric psychiatry outreach service within community social service provider can be an effective means of increasing access to mental health care for a frail elderly population. Careful attention to building trust at the outset of the partnership between different care providers (ie. geriatric psychiatry and the community agency) was essential in making this program a success.