Person-centered Care for Older Adults in the Era of Medicalized Psychiatry

Abstract

Over the last few decades, psychiatry has benefited from the development of safer, increasingly evidence-based treatment and improved access to care through innovations in telehealth and the expansion of community-based psychiatric services. Despite these advances, treatment outcomes for underserved populations continue to lag behind, both in terms of access to and quality of care (Alegeria et al., 2015). These concerns are particularly evident in vulnerable older adults, such as those receiving aging social services, who are more likely to have lower income, lower education, higher needs for activities of daily living and more chronic health conditions (Lee et al., 2015). This population experiences higher rates of depression are observed despite similar rates of mental health treatment and higher rates of psychiatric medication use compared to older adults not receiving aging services (Pepin et al., 2017).A possible explanation for this phenomenon is the field's movement towards biologically focused interventions, leaving the important impact of psychological and social factors relatively neglected. Though ideas such as the “biopsychosocial model” and “patient-centered medicine” are well known and accepted in psychiatry, their impact on clinical practice are curtailed by external pressures for efficiency, the lack of resources, and a fragmented system of care delivery (Mintz, 2022). This shift towards medicalization is exemplified in the ubiquity of the 15-minute “med check” or medication management visits in today's practice of psychiatry. These changes are particularly worrying when applied to older adults, who have more complex medical comorbidities and are at higher risk of adverse effects from medications.In the first presentation, we will discuss the art of prescribing and patient-centered care in the context of older adults. We will provide an overview of non-pharmacological variables affecting treatment outcomes in older adults. We will also discuss the key psychodynamic concepts relevant to psychopharmacology and how they influence treatment outcomes.This will be followed by a case study demonstrating how these practices could be expanded to underserved communities through team-based care for older adults in the community psychiatry setting. The case study will focus on an innovative program to expand geriatric behavioral health services at a Federally Qualified Health Center in Northeast Ohio. It will outline how the program conducted a needs assessment and developed a strategic plan for expanding geriatric psychiatry services by improving the competency of existing staff to assess and treat older adults, collaborating with local geriatric services, and developing a multidisciplinary team-based approach to geriatric behavioral health treatment. Finally, the outcomes of the program will be presented, focusing on both staff experience and patient outcomes.