Telepsychiatry: The Evaluation and Treatment of Seniors in Rural Retirement Communities

Abstract

Few studies examine the benefits from geriatric telepsychiatry in rural retirement communities. Objectives: 1. To demonstrate that using telepsychiatry a) standard approaches to psychiatric evaluation would yield diagnoses in Diagnostic and Statistical Manual of Mental Disorders (DSM-V); b. psychotherapies and pharmacotherapy could be effectively administered. 2. To examine the relationships among cognition, mood, agitation and functions at baseline and the response to treatment over time. Design: Prospective longitudinal study. Measures: Geriatric Depression scale (GDS), Mini Mental State Exam (MMSE), Barthel Index (BI), Pittsburgh Agitation Scale (PAS). Setting: Video Teleconferencing. Interventions: Psychotherapy, psychopharmacology. Participants: 428 Seniors over 55, met criteria for at least one DSM-V diagnosis. Results: Treatments were administered for a full range of psychiatric diagnoses and age-related medical conditions. The most frequently prescribed pharmacological agents were: antidepressants (78%) antipsychotics (64%), memory enhancers (38%). Participants (66%) received psychotherapy: individual (31%), couple (7%), family (13%). Variation in the MMSE scores were observed: 55% remained stable, 11% declined, 18% improved. GDS Scores improved from baseline to 26 weeks (p=0.02, d=0.99: 95% CI 0.39-1.56). PAS scores declined from baseline to 52 weeks (McNemar’s S= 11.27, p=0.0008, d=1.17: 95% CI 0.63-1.68). Function (BI) at week 26 was not statistically significantly different from baseline (t(26)=1.66, p=0.11, d=0.65: 95%CI -0.16-1.42). Participants maintained independence (64.5%) at 52 weeks (McNemar’s S = 6.23, p=0.013, d=0.79: 95%CI 0.19-1.36) Conclusion: This study demonstrates the feasibility and benefit of providing a full complement of services via telepsychiatry to seniors and provides a rationale for more comprehensive reimbursement plans .