geriatric psychiatrist home visit

When To See A Geriatric Psychiatrist

As one grows older, one's medical and mental health needs change, and it may be necessary to shift care to a different kind of doctor. Many doctors specialize in treating the issues that come with old age. For example, a geriatric psychiatrist can help someone in their golden years deal with issues that may come from aging. In this article, we will discuss what a geriatric psychiatrist is and when you should seek one out. 

What is a geriatric psychiatrist?

A geriatric psychiatrist is a medical doctor who has been trained to evaluate , diagnose, and treat mental disorders in older adults.

Sometimes, the psychiatric disorders that geriatric psychiatrists treat are common in people of all ages, such as anxiety and depression, but how they affect an older person may differ. Other times, the disorders are primarily associated with aging, such as dementia. Those who are growing older are more likely to develop a mental illness or other disabilities that make it harder to live a full life. A geriatric psychiatrist understands all the needs of an older person and can work with the person or the person's loved ones to find the best solution for treatment. A geriatric psychiatrist may also be someone for the older adult to talk to about any problems they are experiencing.

Sadly, the field of geriatric psychiatry is in demand. This is not a good sign, as the number of elderly adults—considered to be those over the age of 65—is increasing. 

This means that more doctors need to learn how to take care of an older population. Only 1,700 board-certified psychiatrists specialize in geriatric care. Compared to the millions of adults who are aging, this isn't enough. This is about one geriatric psychiatrist per 27,000 older adults. The number of psychiatrists needed to care for the older population needs to increase in a big way if elderly people are to get the treatment they deserve. Your older years should be a period where you're relaxing and reflecting on your life, not a period of mental suffering. However, for many older adults, their older years are just that.

Why someone would see a geriatric psychiatrist

There are many reasons why someone would see a geriatric psychiatrist. Here are some suggestions of when you should consider seeing a geriatric psychiatrist or taking a family member to see one.

Difficulty coping with change

Being older means you have to deal with changes. Your children are living an independent life. You may lose friends and family. There may be a physical disability that makes it harder to do the things you like to do. It can be difficult to cope with any change, and a geriatric psychiatrist can help you learn how to cope with the changes you're experiencing and accept things the way they are. They may be able to do this through talk therapy or by treating the reasons for the change.

You can lose people at any age, but grief doesn't stop coming when you're older. Your friends, family, spouse, or anyone else close to you can die, and it can be hard for anyone to cope with. A geriatric psychiatrist can help you learn how to cope with grief and make sure it doesn't affect your well-being.

When you're depressed

Depression can happen at any age, but when you're older, it can be terrifying. You can no longer enjoy your life, and you want to do everything while you still can. A geriatric psychiatrist can treat your depression through medication and/or psychotherapy and allow you to live a better life.

When you have a family history of illness

Someone with a family history of Alzheimer's or other mental disorders may want to see a geriatric psychiatrist even if they haven't developed it yet. A geriatric psychiatrist can help figure out your chances of developing the disorder and find ways for you to prevent or cope with it should it develop.

When you have chronic pain

Chronic pain can change how you function, but it doesn't have to be that way. A geriatric psychiatrist can prescribe medication to reduce the pain and allow you to live a fuller life. If you are suffering from chronic pain, don't let it destroy how you live. Learn how you can deal with it—a geriatric psychiatrist can teach you.

When you have a stroke

If you have had a stroke and are dealing with the mental aftereffects, see a geriatric psychiatrist. They can help you to retake control of your life. Don't feel like you have to live with mental pain because you have had a stroke. There is hope.

Heart disease

If you had a heart attack, a geriatric psychiatrist can help you cope with the aftereffects and monitor your health so you don't have another heart attack in the future.

For any mental health disorder

As you grow older, your mental health may deteriorate, and you may have problems with remembering, doing basic tasks, or mental health problems that come with aging. You don't need to have dementia to have lessened cognition. A geriatric psychiatrist can work with you and your loved ones to make sure you have the mental health care you need.

When you need someone to talk to

When you're older, it can be difficult to find someone to talk to. The younger crowd doesn't understand you, and the people your age can be difficult to speak to. A geriatric psychiatrist is specially suited to listen to you and help you be the best person possible. 

For a general checkup

Even if you're an older adult and you feel mentally and physically sound, it's still worth it to see a geriatric psychiatrist. A geriatric psychiatrist can help you to keep your mental abilities up as long as possible, allowing you to live a fuller life. Even if you don't have anything that is currently an issue, a geriatric psychiatrist may be able to help keep it that way.

What to expect

When you or a loved one goes to a geriatric psychiatrist, will the initial process be like? First, you will go in for an evaluation, where they will interview you and ask about your medical and mental health history. With that said, don't be afraid to ask your own questions, such as:

• How will you treat me if I have a disorder?
• What can you do for me if I have an untreatable disorder?
• What is your philosophy on treatment?
• What tools do you have at your disposal?
• What is your payment plan?

These questions can ensure that you have the best geriatric psychiatrist experience possible and find a doctor who best meets your particular needs.

Once they interview the older person and figure out their diagnosis, a geriatric psychiatrist may talk to the family. If the person has a disease where independence will decline, such as dementia, the family needs to know about this to be the caretakers or find good caretakers nearby.

You or your loved one should go to regular sessions if you want to have the best geriatric psychiatrist experience possible. If you're prescribed a medication, it's important to follow up with the doctor about how it's working and discuss any difficulties you're having with it. Your geriatric psychiatrist can change the medicine if you're not doing well with it. If you're going through psychotherapy, regular sessions can help maintain your mental health.

Where you can find a geriatric psychiatrist

Geriatric psychiatrists are available in many places, including:

• Nursing homes. This is where many older people are, and they're often dealing with mental and physical disabilities. A geriatric psychiatrist can help you have the best nursing home experience possible.
• Assisted living facilities. If a person has a disorder such as dementia, they may need help living. You can find geriatric psychiatrists here to help the patient.
• Veteran's care. Aging veterans may be able to receive geriatric psychiatric care.
• A geriatric psychiatrist may also be a researcher, studying how age affects mental abilities and how a person can cope with the challenges that come with aging.

Get online support from a geriatric psychologist

If you or a loved one are having trouble with a mental disorder that has affected your golden years, it's worth seeing a geriatric psychiatrist or . 

If it's difficult to leave your home, you may want to consider online therapy. You will not need to travel to a physical location to get help. All you'll need is an electronic device and an internet connection. Online therapy can be just as effective as in-person therapy.

BetterHelp is an online platform that offers access to licensed therapists. You can get matched to a counselor trained to work with someone in your situation. They will be able to meet with you at a time that works best for your schedule. BetterHelp therapists are also available for caregivers who need an outlet.

Frequently asked questions (FAQs):

What do geriatric psychiatrists do.

In  geriatric psychiatry , a psychiatrist focuses on the psychiatry and neurology of older adults in particular. Geriatric psychiatrists specialize in understanding the disorders and issues that can occur as people age and learn how to treat them. This can range from geriatric mental health to psychiatric disorders, and more. Psychiatrists practice across different age ranges, but geriatric psychiatry is a specialized field. 

What is a geriatric psychiatric evaluation?

A geriatric psychiatry evaluation is a simple process meant to establish a psychiatry and neurology baseline for a person on their first visit. It will consist of interview-type questions to gain a sense of who geriatric patients are and any outstanding mental or physical issues that may exist. This evaluation is also typically used to diagnose a new patient and can successfully evaluate geriatric mental health. Geriatric psychiatrists specialize in evaluating geriatric patients, and their specialized psychiatry training allows them to diagnose common late-in-life psychiatric disorders listed within the American Board of Psychiatry.

What are the most common psychiatric illnesses in the elderly?

Four of the most common mental illness disorders in the elderly are depression, anxiety, bipolar disorders, and eating disorders. Geriatric psychiatrists specialize in diagnosing and treating many of these disorders, which means seeing a geriatric psychiatrist for these mental illnesses can help elderly people who currently live with them.

At what age are you considered geriatric?

In general, a person is considered geriatric if they are over 65 years of age. Geriatric psychiatrists specialize in diagnosing and treating patients within this age group. In addition to potentially visiting a geriatric psychiatrist, those above the age of 65 might also consider visiting a geriatric physician.

Why is dementia not considered a mental illness?

The  National Institute of Mental Health  (NIMH) and the American Board of psychiatry clarify that dementia is not a mental illness. This disorder of the brain can cause memory loss and communication difficulties in geriatric patients and impact a person's general psychiatry and neurology. Still, it is not qualified as a mental illness. The lines between dementia and a similar mental illness often blur, but the former is not technically a mental illness due to the NIMH’s classifications. Despite this, geriatric psychiatry fellowship programs and general psychiatry training help psychiatrists practice treating this mental illness disorder.

Is dementia psychiatric or neurological?

For the most part, dementia is considered to be neurological rather than psychiatric. Geriatric psychiatrists specialize in treating dementia in addition to other mental illness disorders and the improvement of overall geriatric mental health.

What is geriatric behavioral health?

In short, geriatric behavioral health is a field of medicine dedicated to the diagnosis and treatment of mental disorders in older adults. These disorders can include, but are not limited to, dementia, anxiety, sleep disorders, schizophrenia, and more. A geriatric psychiatric fellowship teaches students how to diagnose and treat individuals of elderly age. Unlike an alternative psychiatric fellowship, those in geriatric psychiatry exhibit extensive knowledge of geriatric behavioral health.

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• v.14(1); 2011 Mar

The Practice of Geriatrics: Specialized Geriatric Programs and Home Visits

Home visits have a long history in geriatrics. In this narrative review, the literature on home visits performed by specialists in geriatric medicine (or psychiatry) and/or specialized programs in geriatric medicine (or psychiatry) published between January 1988 and December 2008 was examined. The papers reviewed were few and inconsistent in their message. The lessons that can be derived from them are limited. Draft recommendations about the role of home visiting by specialized geriatric programs in Canada are presented.

INTRODUCTION

House calls (also known as home or domiciliary visits) are visits by physicians to examine patients in their own homes. They have a long history in the care of older patients. Nascher, who coined the word geriatrics , made frequent house calls to his patients. He grew to know New York so well he edited a guidebook to the city. 1

In the U.K., Eric B. Brooke is credited with introducing the practice of domiciliary visits by consultants in geriatrics during the early years of the National Health Service (NHS). 2 After the Second World War, when faced by increasing numbers of older people seeking admission, a finite and inadequate number of beds, and pressure to do something about this mismatch, Brooke began visiting those waiting in their homes. He found that many didn’t require a hospital admission to sort out their problems. His wait list was pruned while the care of older individuals in his district improved. His visits were described as follows:

With Dr. Brooke was his registrar and his secretary. First he had a short talk with the relatives; then he investigated the patient. Then the relatives, the secretary and Dr. Brooke (or the registrar) went over the whole matter and gave advice and decisions, and the secretary made the necessary notes for the case-record. It was all simple, easy, free of fuss. The procedure had a wonderful effect on waiting-lists, and Dr. Brooke was, through his secretary, in constant friendly touch with doctors. 3

During the middle years of the last century, older patients in the U.K. were routinely seen in their homes before admission to a geriatric unit. Arcand and Williamson described this practice in a Scottish professorial unit near the end of its heyday. 4 An astounding 89% of patients were seen at home on the day of referral with two-thirds within 3 hours of the request. Forty-one percent of those seen were subsequently admitted (78% to a geriatric bed). The paper by Brooke referenced by Arcand as justification for home visits recommended that they be performed by social workers, not physicians, and expanding ambulatory services. 5 Lord Amulree and colleagues in a 1951 paper had made a stronger argument for home visits by consultants in geriatrics. 6

Over the last quarter century the frequency of home visits in the U.K. has declined precipitously. In 1986 U.K. consultants in geriatric medicine performed an average of 187.3 domiciliary visits per year (about 3–4 per week). This dropped by 21.4% over the next 5 years. 7 Between 1990 and 1993, there was a 32% decrease in domiciliary visits by geriatricians in Northern Ireland. The need for them had become less pressing. General practitioners (GPs) were now able to arrange direct admissions to hospital for their older patients, refer them to urgent outpatient clinics, and/or obtain immediate access to geriatric day hospitals. 8 Concurrently the number of NHS geriatric beds declined at approximately the same rate. Between 1990 and 1998 approximately a third of these beds were lost. 9 Proportionally more older patients were admitted through the emergency department with fewer directly admitted from the community after a domiciliary consultation. A seminar of Scottish geriatricians reminiscing about domiciliary visits sheds light on the reasons for both the rise and then decline of home visits—and what may have been lost as a consequence. 10

Even more rapid changes occurred in North America. 11 In 1930 an estimated 40% of physician–patient encounters occurred in the patient’s home. By 1993 only 0.88% of older American Medicare patients received a house call from a physician. 12

A wealth of information can be obtained during a home visit otherwise not available. But is this always necessary for the care of patients? If it is, can it be obtained in a more efficient way? Criticisms of home visits include the belief that they are an inefficient use of limited physician time, the difficulty of doing a proper physical examination and/or obtaining investigations in the home, and concerns about practitioner safety. The latter is not a trivial issue. A British study found that 62.5% of all incidents of injurious assaults of GPs occurred during home visits. 13 The Australian Medical Association has published guidelines for the protection of physicians undertaking home visits. Recommendations include providing escorts upon request, keeping timetables for scheduled home visits, reporting in at the end of each visit, following predetermined procedures if a physician can’t be contacted or did not check in when expected, and ensuring that physicians carry a duress alarm and/or mobile phone (GPS-linked if necessary) during visits.

In this paper the relevant literature on home visits will be reviewed with provisional recommendations made on their appropriate role within specialized geriatric programs.

The English-language literature on home visits performed by specialists in geriatric medicine (or psychiatry) and/or specialized geriatric (or geriatric psychiatry) programs published between January 1988 and December 2008 was reviewed. Medline searches restricted to the English language and age 65+ were done using “home visit(s),” “house call(s),” and “domiciliary visit(s)” as search terms. The titles and abstracts of identified papers were reviewed. Based on this, some were selected for detailed study. The references of these articles were in turn searched for additional papers. The emphasis was on home visits performed at the request of primary care physicians to assess common geriatric syndromes like confusion and falls. This review doesn’t deal with the primary medical care of older patients, palliative home care, hospital-at-home programs, home care services, or preventive home visiting.

The available literature is relatively sparse and methodologically weak. There are no randomized controlled trials with blinded assessment of outcomes. The lessons that can be derived from it are limited. Some of the selected articles are becoming dated. The frequency of home visiting declined markedly during the time period examined.

Home Visits by Specialists

Most papers dealing with this topic come from the U.K. The unique history, structure, and funding of health care in the U.K. makes it difficult to extrapolate their findings to other countries. Within the NHS, GPs can ask consultants to see patients in their homes for advice on diagnosis and treatment if these patients are unable to come to an outpatient visit because of their medical condition. An expectation is that the GP will be present during the visit. During the time-frame of this review domiciliary visiting was one of the few clinical services in the NHS that provided an extra fee to the consultant.

Mulley, in a paper about home visiting by consultants, stated that they were being used for purposes other than advising GPs. 14 They were also being done to deal with urgent consultation requests quickly and to assess the appropriateness of a patient for a hospital admission. Most home visits were to older people with psychiatric or nonspecific symptoms. He noted that “…the charge that some visits are unnecessary cannot be ignored.” Potential advantages for them (compared to an outpatient assessment) suggested by the author included the ability to obtain collateral history from people who tend not to come in to clinic visits; more valid cognitive evaluation; ability to look for signs of self-neglect (e.g., aroma of urine); ability to inspect the home for medications, fresh food, signs of alcohol abuse, bed not slept in, problems with hygiene, damp, poor lighting or heat, accident hazards, and environmental hindrances; ability to assess caregivers; chance to reassure the patient; ability to obtain blood samples and/or an ECG; teaching opportunities; and, after a home visit, improved ability to develop a realistic management plan. Potential disadvantages were that physical examination is often difficult; making home visits is time consuming; home visits are expensive; and it is unclear whether they are cost effective.

Hardy-Thompson and colleagues found that most (67%) GPs who completed a questionnaire indicated that a psychogeriatric domiciliary visiting service was very important to their work. 15 Both psychogeriatric consultants who participated in the study felt that “a proper assessment of dementia [the commonest clinical indication for a visit] meant seeing the patient’s home and an informant.” The same authors compared high GP users of the psychogeriatric domiciliary visiting service (i.e., GPs who requested 2+ domiciliary visits in the last 6 months) with less frequent users. 16 High GP users were more satisfied with the service, were more likely to come to the visit, and felt that physical disability was an important factor in making their request. They were less likely to have psychiatric training and more likely to feel susceptible to pressure from the patient’s family. Several years later one of the co-authors of these papers wrote that old-age psychiatrists “cannot…justify home visits on the emotional basis of our personal fondness for them…particularly…in light of the growing popularity of multidisciplinary community teams in old age psychiatry…[which] allow for such assessments to be carried out by any team member.” 17 An audit found that less than a third of domiciliary consultations by a psychiatric service met required criteria for their performance. 18

Donaldson and Hill reported that most consultants and GPs in the U.K. used domiciliary consultations sparingly, with GPs rarely turning up for them. 19 They raised several concerns: the problems being seen were often minor; at times visits were being done as a prerequisite for admission to hospital; and some those seen could have come in for an assessment. Peer-review auditing led to a substantial decline in the number done. An accompanying editorial concluded that home visits “do seem to have a place, albeit a limited one.” 20 Reardon et al . retrospectively reviewed domiciliary consultations carried out by two hospital-based care-of-the-elderly physicians in the U.K. 21 Over a year one physician did 184 consultations with the other performing 268. Respectively, 29.9% and 20.9% of their patients were admitted to hospital after consultations. The equivalent figures for geriatric day-hospital admissions were 23.9% and 29.1%. The consultants felt they had “something to offer” in 92.4% and 81.3% of the consultations, respectively, concluding that domiciliary visits were a “useful service.” Crome et al . conducted an audit of domiciliary consultations done over a 3-month period in their region of the U.K. 22 Six geriatricians performed 234 consultations (range in the number of visits/physician was 0–74). Most (78.6%) visits occurred after normal work hours. GPs rarely (1.6%) attended. The most common reasons given by GPs for having their patients seen at home were either difficulty in attending an outpatient visit due to the severity of the patient’s illness (31.9%) or immobility (26.4%). Rarely (4.6%) was it because the GP felt that it would be better to have the patient assessed at home. The authors suspected the “real” reasons were to have patients seen more quickly or to expedite hospital admission. Nearly a quarter (24%) of those seen were admitted. Most (93.5%) GPs thought the visits were of value.

None of the studies reported objective patient outcomes. While there seems to be a role for home visits by specialists, it appears that many of those being performed in the U.K. were not absolutely required. As Mulley concluded, “…if they are to continue as an important part of our health service they must be done responsibly and evaluated thoroughly.” 14

Cognitive impairment/dementia

In the U.K. patients with dementia are often initially seen in their own homes by geriatric psychiatrists. There is pressure on these programs to reallocate resources from home visiting to memory clinics. A study compared 76 consecutive new referrals to a geriatric psychiatry service for assessment of memory problems where the patient was assessed in a memory clinic versus 74 consecutive new referrals to the same service where a specific request was made for a domiciliary visit to assess the patient’s memory concerns. 23 Both were done over the same period of time. The domiciliary group had more behavioral and psychological problems. The authors felt memory clinics could complement domiciliary services but not replace them.

Another study looked at 64 consecutive referrals to a memory clinic. 24 A community psychiatric nurse initially assessed them at home using a semistructured interview. A nurse diagnosis of dementia agreed well with the final clinic diagnosis, but there was only moderate concordance on the type of dementia. The authors felt that a physical examination and neuroimaging were important in making a specific etiological diagnosis. An earlier study had come up with similar findings. 25 While the high concordance in diagnosing dementia is reassuring, probable dementia can be detected using informant questionnaires. 26 In a research study identification of the presence of dementia by trained nurse assessors after a 90–120 minute in-home assessment showed very good agreement with the final consensus diagnosis (kappa = 0.84), and good agreement with regard to the type (kappa = 0.71). 27 A specialist nurse role was developed in a U.K. memory clinic. 28 These nurses conducted a home-based assessment, formulated an initial diagnosis, and facilitated further assessments/investigations. All patients were subsequently seen by another discipline with the final diagnosis made at a multidisciplinary meeting led by a consultant in old-age psychiatry. This retrospective 18-month study compared the diagnosis made by the nurse with the one made at the multidisciplinary meeting. The two nurses saw 184 and 220 patients, respectively, over the 18 months (127–147/year). There was very good agreement on the diagnosis of dementia (kappa = 0.88) and good agreement for the type of dementia (kappa = 0.76). The authors concluded that “nurse screening” was a way to provide an earlier diagnosis. The multidisciplinary team review was felt to guard against inaccurate diagnoses and/or inappropriate care. It was concluded that there was an “unrealized potential for nurses to become more involved in diagnosing early and uncomplicated cases of dementia in the community.”

An American study compared a structured clinic-based assessment of older demented patients with a similarly structured home assessment. 29 The focus here was not on the diagnosis of dementia but on the identification of problems. Trained geriatric nurse specialists conducted the assessments. The ones done at home were taken as the “gold standard.” A staggering 1,751 problems were identified (8.76 per patient) in the patients enrolled in this study, with many of the identified problems given a high-risk score (defined as risk of death or serious morbidity some time in the future) by the investigators. Many ( n = 622) problems were identified only during the home visit, but a nearly equal number ( n = 597) were only identified during the clinic visit. Most (61%) of the home visits lasted 90+ minutes compared with 12% of office visits. Longer visits led to the identification of more problems. While the authors concluded that home visits were beneficial, methodologically this was a weak study. About as many problems were identified only during clinic visits as on home visits. No data on patient outcomes were presented. An unanswered question was whether the identification of all these problems actually led to changes in management and better outcomes. These authors published a paper 15 years earlier with similar results and conclusions. 30

The location of the evaluation can have an impact on the results obtained on even brief cognitive measures. A study of older patients in a family practice found that Mini-Mental State Examination scores were on average 0.5 points higher if done at home than in the office. Patients tended to do better on three-item recall and spatial orientation. 31 In another study the average difference between the two settings was 1.5 points with differences of 5+ points in 25% of cases. Most (76%) participants did better at home. 32 It isn’t clear which score is more useful for either assessment or management, but this is another source of variability in the results obtained on testing that should be kept in mind.

Trained nurses who are part of a multidisciplinary service can diagnose dementia on home visits, but there is less confidence in their ability to make an accurate determination of the likely cause. Whether the additional information obtained during a home visit influences management and improves outcomes can’t be answered by the available literature.

A quasirandomized controlled trial enrolled 95 women aged 60+ living in the community receiving in-hospital rehabilitation for a fall-related hip fracture. 33 The women were alternately allocated to the intervention or control group. All took part in a fall prevention program during their inpatient stay with the intervention group also receiving a home visit for an environmental assessment by an occupational therapist a median of 20 days after discharge. Falls within the first 6 months were examined. A total of 13/50 in the control group had 20 falls over 9,231 days of observation. In the intervention group 6/45 had nine falls over 8,970 days. There was a significantly lower proportion of fallers in the intervention group (odds ratio 0.275, 95% confidence internal 0.081–0.937, p = 0.039). The authors concluded that an occupational therapist home visit after discharge significantly reduced the risk of falling in this study. Positive results were also found in an earlier study of high-risk (i.e., those reporting 1+ falls in the year prior to recruitment) patients being discharged from hospital. 34

A systematic review concluded that home safety interventions were possibly effective in preventing falls if they were part of a multifactorial intervention, or targeted to those with severe visual impairment or otherwise at high fall risk. 35

Medications

One reason commonly given for a home visit is to more accurately assess the medications being consumed. One study compared drug histories obtained by an internist in a clinic with those obtained by a nurse practitioner during a home visit. 36 The two lists disagreed 32% of the time with roughly equal numbers of “extra” drugs noted in the two settings. It wasn’t clear which one was more accurate. The authors argued “against uncritical acceptance” of the widely held assumption that the drug history obtained on a home visit was the gold standard. To accurately determine drug use the authors suggested asking repeatedly, having all medications brought to clinic visits, and getting data from additional sources (e.g., pharmacy records, administrative databases).

In a Canadian study, medications identified at an in-home assessment (by semistructured interview followed by a room-by-room search) were compared with lists obtained at clinic visits (by interviewing the patient and examining all their medications, which they were asked to bring). 37 In 23/48 patients (48%) the clinic list missed at least one regular medication (9/48 a prescribed one). At the clinic visit, eight patients (17%) reported taking a medication that was not found on the home visit. The in-home interviews/inspections took 42 minutes making them impractical for routine use. More explicit questioning at the time of the clinic visit coupled with clearer previsit directions to look for all medications in the home might improve the yield of lists obtained during a clinic visit.

Miscellaneous

In a Canadian study, Clarfield and Bergman described how medical services were arranged for a group of 105 housebound seniors in an urban setting. 38 After being identified, they were assessed and stabilized by a specialized geriatric service before being matched to family physicians willing and able to assume their care. Of those followed at 1 year, most (69%) were still at home. The majority (83%) were pleased with their medical care. The authors concluded that assessment and stabilization coupled with backup consultative services made it possible to find family physicians willing to assume the care of these housebound patients. Most of these housebound patients were still at home a year later.

Home visits can play a role in the education of practitioners. During a family medicine clerkship in Israel, family physicians visited a bedridden older patient at home with a small group of medical students and a geriatrician from the local hospital. Students rated the home visit highly. The experience allowed students to learn aspects of geriatrics not previously presented. 39

RECOMMENDATIONS

Within specialized geriatric programs, home visits have evolved from a service performed by physicians for a specific indication (screening for appropriateness of hospital admission) to one done by variety of professionals for diverse reasons. While assessing the need for hospitalization is still a valid reason for a home visit, most admissions to a geriatric unit now occur through emergency departments, through clinics, or as intra-/interhospital transfers.

Home visits remain an important component of the comprehensive suite of services required by frail seniors. It is an activity that can be ramped up quickly, as the required infrastructure is minimal. More rigorous research on home visits is needed. We must be better at defining who should be seen at home (and by whom); determining what specifically should be done; examining how best to link home visits with our other activities, primary care, and community-based programs; and evaluating their effectiveness. Safety issues coupled with the time and resource implications of these visits mean that they should be targeted and planned. The potential role of old (e.g., telephone) 40 and emerging technologies (e.g., home-based information and communication technologies) to augment or replace home visits should be examined. 41 Telephones, for example, can be used to screen/triage, assess, monitor/follow, and counsel/reassure patients.

The American Geriatrics Society developed a clinical practice statement on house calls in geriatric practice. 42 Based on this, the literature review, and personal experience, provisional recommendations about home visits for Canadian specialized geriatric programs are proposed as a starting point for further discussion (see Table 1 ).

Provisional recommendations about home visits for specialized geriatrics programs in Canada

They should be a planned service and not an afterthought. Decisions about who will perform the visit should be driven by patient need, available resources, program structure, and professional judgment about appropriateness. Particular challenges for physicians are determining which ones should be done personally and how best to develop and maintain skills in assessing and managing patients in their own homes.

Technological advances, consumerism, and efforts at cost containment are all driving health care increasingly back to the home. 43 Some primary care geriatricians have shifted into what has been called a house call practice . 44 While individual physicians can successfully adopt this type of practice, a specialized geriatric program would be ill advised to move entirely this way—as ill advised as retreating to the borders of the hospital. Rather we must develop an integrated, comprehensive suite of services that includes home visiting to meet the needs of the older population we serve.

CONFLICT OF INTEREST DISCLOSURES

None declared.

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ALACRITY Methods Development

ALACRITY has a Research Methods Core that provides quality control for the Center’s projects, serves as an incubator for innovative approaches to novel design and analytic methods that enhance the information yield of effectiveness data. It also uses big-data to aid the identification of populations in need of novel interventions, provides policy support, and integrates novel mobile technology approaches to community interventions. The Methods Core also evaluate the Center’s productivity and impact on the field and disseminates its methodological advances. 

Our Center proposes a novel deployment focused model that both streamlines behavioral interventions for late- and mid-life mood disorders and improves their delivery in the community. In response to the Center’s and the field’s needs, the Research Methods Core (RMC) is developing novel methods outlined in three initiatives.

Novel Statistical Methods and Software

Research Methods Tutorials

Our Community Partners

A central part of the ALACRITY Center’s mission is to develop novel treatments for late- and mid-life mood disorders that can be tested and used in the community. For this reason, the Institute uses neurobiology models to identify core therapeutic components of psychotherapies. It uses these models to simplify its psychotherapies, while retaining their therapeutic properties, so that they can be used in busy community settings. To ensure that the novel psychotherapies are practical and fit in the routine of community settings, our investigators work closely with community partners both during the development and the testing of the new psychotherapies. Our ultimate goal is to develop treatments that can be used across the nation and be sustained without the support of research grants. 

Training and Career Development

The Weill Cornell Institute of Geriatric Psychiatry oversees, coordinates, and delivers all research and clinical training in Geriatric Psychiatry at the Weill Cornell Medical Center. Its programs train medical students, psychiatric and medical residents, psychology interns and fellows, geriatric psychiatry and geriatric medicine fellows, and post-graduate scientists in fields related to Geriatric Psychiatry. The Institute also has formal structures and mentorship programs aiming to promote career development of early career investigators of Weill Cornell Medicine and at a national level.

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Screening and assessment tools.

Screening tests for mental health problems are usually brief self-administered questionnaires.  They are useful for identifying people with the targeted mental health conditions (e.g. depression).  They are designed to have “high sensitivity’ and capture the vast majority of their target mental health problems. However, they are not very “specific” to the mental health problem they are designed to identify. Therefore, a positive screen does not establish that the target mental health problem is indeed present but alerts to the need for further examination by a clinician.

Join Our Treatment Studies

The physicians at Weill Cornell Medicine/NewYork-Presbyterian are dedicated to the pursuit of breakthrough research, and the safe and ethical management of clinical trials. Research study volunteers play a critical role in determining the effectiveness of new therapies and treatments. By participating in clinical trials, you may gain access to new research treatments before they are widely available. Healthy volunteers are also needed for many studies.

If you are interested in learning more about a specific study or area of research, please search below by area of research.

Research Studies

The Institute’s research encompasses a continuum of studies in late-life depression and cognitive impairment in three interrelated areas: 1) Neurobiology of late-life mood disorders; 2) Development and testing of neurobiology-based novel treatments; and 3) Interventions aimed to improve the delivery of empirically validated treatments in diverse community settings. The Institute’s research program is supported by an NIMH ALACRITY Center Grant by NIMH, a number of R01, R61/R31 grants and U contracts by NIMH and NIA, and private donations.

The Institute’s human neurobiology studies seek to identify aging-related brain abnormalities interfering with the response of late-life mood disorders to treatment. Informed by neurobiology, the Institute’s investigators are developing and testing novel therapies for depressed older adults at risk for poor response to conventional antidepressants. Examples of such therapies are Engage (a treatment targeting the brain’s reward networks), problem solving therapy for depression with executive dysfunction, ecosystem focused therapy for post-stroke depression, problem adaptation therapy for depression with mild dementia, cognitive reappraisal intervention for suicide prevention, interventions for depressed patients with chronic medical diseases or severe mood disorders, computerized cognitive remediation, and transcranial magnetic stimulation. The Institute has led NIMH supported treatment studies in geriatric bipolar disorder, psychotic depression and electroconvulsive therapy. The Institute seeks to improve mental health services and to reduce disparities using strategies for depression screening and for engagement in empirically validated interventions offered in community practice settings. The Weill Cornell ALACRITY Research Center implements a novel model of deployment-based behavioral interventions and implementation, streamlined based on neurobiology models and augmented by mobile technology. Rather than focusing exclusively on uptake and sustainability of available interventions, many of which are too complex for community use, the Weill Cornell ALACRITY Center investigators are working to both simplify the treatments themselves and improve their delivery. To maximize the impact of its research program, Weill Cornell ALACRITY investigators work both in settings in which most older and middle-aged people receive care (primary care) and in settings serving persons with special clinical (elder mistreatment) and social needs (poverty). 

Clinical Care

The Weill Cornell Institute of Geriatric Psychiatry has one of the largest academic clinical services in the nation. It provides psychiatric care to older psychiatric outpatients, inpatients, nursing home residents, and primary care patients. Outpatients eligible for research studies are offered detailed free of charge clinical assessment and psychotherapy or medication treatment. For more information please visit Join Our Treatment Studies.

• NewYork-Presbyterian Westchester Behavioral Health Center (21 Bloomingdale Rd, White Plains, NY):  The geriatric clinical service consists of a 22 bed acute Inpatient Unit, the Psychiatry Outpatient Practice for Older Adults (914-997-5970), and a Nursing Home Consultation Program.
• NewYork/Presbyterian/Weill Cornell Medical Center in Manhattan (525 East 68th Street, NY, NY): The Institute oversees a Geriatric Psychiatry Clinic and a Geriatric Track for older adults admitted to the inpatient unit of Payne Whitney Clinic of the Weill Cornell Medicine's Department of Psychiatry. It also offers geriatric psychiatry services to primary care older patients of The Irving Sherwood Wright Center on Aging (1484-1486 First Ave, NY, NY 10021; 212-746-7001), a geriatric medicine outpatient service.
• The Institute of Geriatric Psychiatry’s Faculty Practice: The Practice offers outpatient care to private pay individuals in Manhattan and White Plains.  We use our clinical and scientific experience to provide state-of-the-art treatment for young and older adults.  Our services include a comprehensive evaluation of psychological symptoms, stressors, medical illnesses, disability, and social factors.  We offer neuropsychological evaluation, cognitive remediation, and specialized psychotherapies tailored to the needs of individual patients. These include cognitive behavioral therapy, problem solving therapy, dialectic behavioral therapy, interpersonal psychotherapy, dynamic psychotherapy, and psychotherapy for cognitively impaired patients and for patients with ideas of suicide.

The specialization of members of the Institute’s Faculty Practice can be found in their individual webpages: Theodora Kanellopoulos, Ph.D. ( https://weillcornell.org/tkanellopoulos , Phone: 914-997-5201), Dimitris N. Kiosses, Ph.D. ( https://weillcornell.org/dimitriskiosses , Phone: 646-962-2820; 914-997-4381), Patricia Marino, Ph.D.,( https://weillcornell.org/patmarino , Phone: 914-997-8691), , Jo Anne Sirey, Ph.D.,  https://weillcornell.org/jasirey , Phone: 914-997-4333), Victoria M. Wilkins Ph.D., https://weillcornell.org/vmwilkins , Phone: 914-682-5411).

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Ethical Issues in Geriatric Psychiatry (April/May/June) | 2024

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Dr. Collier is the director of education in the Division of Geriatric Psychiatry at McLean Hospital and an instructor in psychiatry at Harvard Medical School. Dr. Collier completed her psychiatry residency at Duke University Medical Center and fellowship in consultation-liaison psychiatry at Brigham and Women’s Hospital. Dr. Collier teaches and supervises medical students, residents, and fellows in geriatric psychiatry, and she works on projects training non-specialist clinicians in resource-limited settings.

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5 Benefits of Geriatric Home Visits

By Ashley Barnes, M.S.

Geriatric Healthcare

Geriatric healthcare is the attentive medical care given to those over the age of 65 who are also referred to as seniors. Many individuals don’t seek geriatric healthcare until well into their 70s, 80s, or even 90s. A subspecialty in geriatric healthcare is geriatric psychiatry, as geriatric mental healthcare is a crucial aspect of geriatric healthcare in general. The American Psychiatric Association (APA) describes geriatric psychiatry as addressing the “ biological and psychological aspects of normal aging, the psychiatric effect of acute and chronic physical illness, and the biological and psychosocial aspects of the pathology of primary psychiatric disturbances of older age” (APA, 2021). 

Main focal points in geriatric psychiatry pertain to the “prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly and improvement of psychiatric care for healthy and ill elderly patients” (APA, 2021). Some of the most common psychiatric concerns that present in this population entail mood disorders such as depression and neurocognitive disorders such as dementia. 

Home Visits 

In an home visit, a psychiatrist visits a senior patient in their own living space as opposed to the seniors having their visit in the psychiatrist’s office. 

5 benefits of Home Visits from a psychiatrist:

Enhances Socialization – Home Visits reduce loneliness and isolation amongst seniors, as sessions provide socialization and address mental health concerns simultaneously. This is especially important for seniors, as a wealth of research indicates socialization among older adults can decrease the risk of developing dementia and Alzheimer’s disease. Further, socialization can counter the depression symptoms that come along with isolation.

Reduces Transportation Strain – Home Visits can be a huge benefit to seniors who are home-bound and have limited transportation options. Attending appointments at a doctor’s office can be a tedious and strenuous task for an elderly patient, especially if they are immunocompromised or struggle with a disability. Home Visits alleviate these concerns by simplifying the process and reducing strain on elderly patients, as the doctor will come to the patient.

Comfort – Home Visits take place in an elderly patient’s home where the patient feels safe, comfortable, and at ease. Being in a comfortable environment can in turn help patients feel more comfortable and open during a Home Visit with a psychiatrist. This can lead to positive mental health outcomes, as it may enhance collaboration in treatment planning and reaching treatment goals.

Improving Wellbeing – According to a wealth of research and the Centers for Disease Control and Prevention,  feelings of loneliness and isolation can have negative effects on our general health . This is even more so for the elderly members of our communities as they are more at risk for health problems. Home visits can help geriatric patients feel more connected to a support system, can counter social isolation, and negate the negative health outcomes associated with social isolation.

Accessibility to Psychiatric Care – Mental health professionals are crucial resources for those experiencing more severe and impairing symptomology. Fortunately, geriatric psychiatrists have focused their clinical attention and training on the concerns of our aging population, knowledgeable and experienced in treating their mental health concerns. Geriatric psychiatrists can prescribe medication to help geriatric patients manage and better cope with their symptoms, meet with family members or other physicians to coordinate care, and some can even provide psychotherapy along with medication management. 

At the Mental Health Center , Lydia Ann, MD offers at-home sessions coming from Van Nuys, California; Dr. Ann charges her standard session rate for the commute to a patient’s home, the visit itself, and the commute back. Additionally, Miriam Winthrop, MD offers at-home visits for geriatric patients, also charging her standard session rate for the commute to a patient’s home, the visit itself, and the commute back. For more information, feel free to contact our team at (310)601-9999.

Let Us Support You

Here at the   Mental Health Center we have skilled geriatric psychiatrists ready to support you and your loved ones.

• Jooyeon Lee, MD – Dr. Lee is a psychiatrist specializing in general adult and geriatric psychiatry. She has worked with patients from diverse backgrounds in various settings including academic institutions, city/county hospitals, and the Veterans Administration Hospital. She is board-certified by the American Board of Psychiatry and Neurology, and board-certified in Geriatric Psychiatry. Dr. Lee was selected for the American Association for Geriatric Psychiatry Honors Scholars Program for Residents in 2017. Her work has been published in journals including Experimental Gerontology, Dialogues in Clinical Neuroscience, and the Journal of Clinical Psychopharmacology.
• Lydia Ann, MD – Dr. Lydia Ann is a psychiatrist specializing in general adult psychiatry and a current geriatric psychiatry fellow. She has extensive experience treating patients of various backgrounds in multiple settings, including outpatient, inpatient, partial hospitalization, crisis residential program, emergency department, and corrections. Due to this broad experience, she emphasizes the importance of care coordination and integration of one’s entire support system to bring excellent, individualized care to each patient. Dr. Ann is completing further specialized training in geriatric psychiatry fellowship at UCLA.
• Miriam Winthrop, MD – Dr. Miriam Winthrop is a board-certified psychiatrist specializing in adult and geriatric psychiatry. She believes in taking a holistic approach to addressing mental health. In addition to her expertise in the use of medications, she has extensive training in multiple types of psychotherapy, including cognitive-behavioral and insight-oriented modalities. Dr. Winthrop has extensive experience working with a wide range of issues, including depression, anxiety, PTSD, OCD, dementia-related concerns, and end-of-life issues. She received her medical degree from the Keck School of Medicine of the University of Southern California. She completed her residency in adult psychiatry at LAC+USC Medical Center. She completed her fellowship in geriatric psychiatry at the David Geffen School of Medicine at UCLA. She was selected as an Honors Scholar in the American Association for Geriatric Psychiatry and received the award for excellence in psychotherapy from the Austen Riggs foundation.

Online Resources.

• Health in Aging – a service from the American Geriatrics Society gives information for older adults/family members regarding mental health concerns.
• Alzheimer’s Disease and Related Symptoms – a resource from the National Institute on Aging provides articles and advice for coping with cognitive impairment and Alzheimer’s.
• Cognitive Aging Efforts – created by the American Psychological Association, this site offers up-to-date webinars and informative publications regarding common geriatric concerns.

American Psychiatric Association. (2021). Geriatric Psychiatry . American Psychiatric Association. Retrieved December 17, 2021, from https://www.psychiatry.org/psychiatrists/practice/professional-interests/geriatric

Privacy Overview

• Adult and Geriatric

Our multidisciplinary team of board-certified psychiatrists and behavioral health professionals offer specialized expertise in geriatric psychiatric treatment. We understand the unique needs and challenges facing older adults with mental health conditions. Some of the disorders we commonly treat include late-life depression, anxiety, bipolar disorder, memory disorders, and more.

The My Psychiatrist geriatric team specializes in psychiatric treatment for Alzheimer’s and dementia, along with the accompanying behavioral disturbances such as agitation, aggression, paranoia, and mood abnormalities. Our goal is to relieve symptoms and help older patients develop skills to increase their independence and mobility. We achieve this by focusing on proper assessment and diagnosis, management of co-existing conditions, medication adjustment, family education, and consultation with other health professionals.

Types of Geriatric Psychiatry Services

At My Psychiatrist, we offer two treatment options for older adults.

Outpatient Care

Geriatric patients can come to one of our South Florida offices for treatment.  Our outpatient services  allow patients to meet with their therapists face-to-face. Many patients benefit from receiving treatment in our offices, as it’s a distraction-free environment that helps them focus.

Telemedicine Services

We also offer  elderly mental health services online . With our telehealth services, patients can schedule a live, virtual appointment with their providers to receive the care they need from the comfort of home.

The Benefits of Psychiatric Telehealth Services for Seniors

Telehealth services allow patients to receive psychiatric treatment without in-person contact. Older adults can chat with their therapists via internet using their computer, phone or tablet.

Telepsychiatry is a safe, convenient option for seniors. Explore some of the benefits of geriatric telepsychiatry services.

1. Accessibility

One of the biggest obstacles older adults face when starting therapy is getting to their appointments. Those who don’t drive must rely on public transportation, a friend or relative to get them to their appointments, which may not always be convenient. Older adults with health issues may also find it uncomfortable to travel or be physically unable to do so.

Telehealth services remove the transportation barrier, allowing patients to connect with therapists from home. By reducing transportation issues and scheduling conflicts, telehealth services help older adults remain consistent with their appointments. Consistency is crucial for effective psychiatric treatment.

Some patients are concerned about protecting their privacy and hesitate to visit a physical office location. Telehealth service is one of the most discreet ways to receive psychiatric treatment. Seniors who aren’t comfortable going in person often feel more at ease when they can participate in therapy from the privacy of their own homes.

At home, older adults typically have everything they need at their disposal, eliminating concerns about managing pain, incontinence and other issues that may arise when traveling to a new place.

4. Health and Safety

Telehealth services can help reduce health and safety concerns for seniors. Virtual sessions eliminate the risk of catching or spreading an illness at the office, which is vital for seniors with health issues that make them vulnerable to complications.

Telehealth appointments can also reduce the risk of accidents. Seniors who have difficulty walking or getting around can avoid obstacles like stairs and unfamiliar places by having an online mental health appointment.

Our board-certified psychiatrists specialize in the following geriatric psychiatric conditions:

Alzheimer’s Disease

Dementia with behavioral issues, obsessive compulsive disorder, late-life depression, chronic pain, book an appointment online today.

Whether you’re seeking care for yourself or a loved one, My Psychiatrist is a top elderly mental health provider offering in-person and online services.  Schedule an appointment  with one of our adult mental health professionals in South Florida today. We have offices in Miami, Hollywood, Oakland Park, Boca Raton, and Orlando.

Whether you choose in-person or telemedicine services, our board-certified psychiatrists and nurse practitioners will provide an accurate diagnosis and personalized treatment plan to meet all your needs.

Talk to someone whenever you need.

Our team of board-certified psychiatrists and therapists are here for you when you’re feeling anxious, stressed, down, or just not like yourself.

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What is Geriatric Psychiatry?

Geriatric psychiatry is a specialty focused on preventing, evaluating, diagnosing, and treating emotional and mental disorders in older adults.

Geriatric psychiatrists are psychiatrists that specialize in the diagnosis, care, research about, and treatment of mental conditions affecting older adults. The specialized field of geriatric psychiatry is also commonly referred to as geropsychiatry, geripsych, geri-psychiatry, or psychogeriatrics. Geriatric psychiatrists provide care to their patients in a wide variety of settings, such as private practice, hospitals, assisted living facilities, in-patient care centers, and veteran care centers.

As people learn more about living healthier lives, our lifespans continue to increase, and the demand for geriatric psychiatrists is also going to increase. According to the U.S. Census Bureau, the current average lifespan for an American is 78.8 years, while in 1960, the average life expectancy was 69.66 years.

A Rising Need for Geriatric Psychiatrists

Numerous studies have repeatedly confirmed the increasing incidence of mental illness among the aging population.

The proportion of the population over age 65 will increase from 12.4% of the U.S. population in 2000 to 20% by the year 2030 (U.S. Census Bureau, 2000). During the same time, the number of older adults with mental illness is expected to double to 15 million (Jeste et. al., 1999).

This demographic transition will increase the current shortfall of health care providers with geriatric expertise − and specifically health care providers with geriatric mental health expertise. Since 1990, approximately 2,500 psychiatrists have received subspecialty certification in geriatric psychiatry. This supply of physicians is woefully inadequate to meet the future needs of the nation. According to estimates in the President’s Commission on Mental Health Subcommittee on Older Adults (2003), "at the current rate of graduating approximately 80 new geriatric psychiatrists each year and an estimated 3% attrition, there will be approximately 2,640 geriatric psychiatrists by the year 2030 or one per 5,682 older adults with a psychiatric disorder." It has been estimated that 4,000 − 5,000 geriatric psychiatrists who provide patient care are needed (National Institute on Aging, 1997) and an additional 1,220 physician faculty members and 919 non-physician faculty members who provide training in geriatric psychiatry to meet the future demand.

"Think young–or old. Psychiatrists who want to land the best jobs . . . will go after training in child and adolescent psychiatry or geriatric psychiatry, job market experts tell us. While no hard numbers are yet available, recruiters have also seen a recent upturn in the number of requests for clinicians trained in geriatric psychiatry. And, based on the aging of the population and the prospect of better Medicare reimbursements for psychiatric treatment, geriatric training is a good long-term bet."

- CLINICAL PSYCHIATRY NEWS, JANUARY 1999

Geriatric psychiatric training requires 4 years of medical school, 4 years of approved residency training in general psychiatry, and 1 year of specialty fellowship training in psychiatric work with older adults in an accredited residency in geriatric psychiatry.

In the general psychiatry training years, the physician achieves competence in the fundamentals of the theory and practice of psychiatry. In the geriatric psychiatry training, the trainee acquires a thorough knowledge of specific body of scientific knowledge about aging and mental health including patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, professionalism, and system-based practices.

To find a list of accredited geriatric psychiatry fellowship programs, please visit the   Accreditation Council for Graduate Medical Education website .

Certification

When the psychiatry resident has completed their geriatric psychiatry fellowship and successfully passed the certification examination in general psychiatry given by the American Board of Psychiatry and Neurology (ABPN), they are eligible to take the additional certification examination in the subspecialty of geriatric psychiatry.

Although the ABPN examinations are not required for practice, they are an assurance of excellence and an indication to patients and employers of expertise in geriatric psychiatry.

For more information on certification in geriatric psychiatry, please refer to the  American Board of Psychiatry and Neurology, Inc. website .

"Members of the American Association for Geriatric Psychiatry who have received their subspecialty certification report a higher salary level than those who have not sat for and passed the certification exam."

- AAGP MEMBERSHIP SURVEY, 2003

Career Satisfaction

"Physicians who specialize in the treatment of children, newborns, the elderly, and skin disorders and who practice in the New England and West Central regions of the country are more satisfied with their careers than their colleagues in other specialties and regions."

- Researchers at UC Davis School of Medicine and Medical Center  

August 2002

"In a national survey of fellows who had trained in geriatric medicine and psychiatry, the vast majority of former fellows expressed satisfaction with their current work. Satisfaction with a career choice in geriatrics was significantly greater among those physicians who had practices with large numbers of patients over 75, accepted Medicare assignment, spent their time as clinician-researchers, and had a medical school appointment."

- Siu, Al; Beck, JC; UCLA Department of Medicine

1990 Career Development Opportunities in Geriatric Psychiatry

"In fact, a recent study found that geriatric physicians were more likely to have very high career satisfaction than physicians from 32 other specialties."

- Archives of Internal Medicine

AAGP Mentoring/Training Programs

The American Association for Geriatric Psychiatry (AAGP) has several programs for medical students, residents, and fellows for the purpose of increasing exposure to and interest in geriatric psychiatry. These programs have been very successful in that students, residents, and fellows have had the opportunity to be mentored by senior geriatric psychiatrists, attend the AAGP Annual Meeting, receive the scientifically peer review journal, the American Journal of Geriatric Psychiatry, among other benefits and programmatic components. For the latest information on available AAGP mentoring/training programs, please visit www.AAGPonline.org /scholars .

NIH Research Loan Repayment Program

The National Institutes of Health offers Loan Repayment Programs to attract health professionals to careers in clinical, pediatric, health disparity, or contraceptive and infertility research. In exchange for a two or three-year (for Intramural General Research) commitment to your research career, NIH will repay part of your qualified educational debt . In addition, the NIH will make corresponding Federal tax payments for credit to your Internal Revenue Service tax account that you incur as a result of your LRP benefits. For more information, visit the NIH website at   www.lrp.nih.gov .

How to Find a Geriatric Psychiatrist

To support the overall health and well-being of older adults, it is as important to address your mental health just as you would physical health. You will need to surround your aging loved ones with a dedicated support team. This can include family members, caregivers, and mental health clinicians. 

Depending on where you live, you may or may not have easy access to a geriatric psychiatrist, but often you can find providers that offer virtual services. Use the  American Association for Geriatric Psychiatry’s database  to search for the a geriatric psychiatry specialist in your state.

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Expert Geriatric Care

Brooklyn HouseCall is the premier physician group visiting seniors at home throughout the Brooklyn area of New York. Through regular home visits we are able to monitor and maintain the health and well being of our patient, keeping them healthy and out of the hospital

• Personalized care in the comfort of your own home
• The price is right – as a participating Medicare group, all procedures and visits are covered by Medicare
• Comprehensive review of your medical history, physical examinations and treatments
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• Blood work done in your home
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• Our doctors will oversee all aspects of your care
• Physician review for authorizations of Home Health care, medical equipment, or diagnostic testing
• Daily hospital rounds to see admitted patients

Call Us Now at 718-360-9370

We’re available to answer you questions and help you choose the home healthcare service you need.

• ©Copyright 2009 Brooklyn Housecall All rights reserved.

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The Socio-Economic Profile of the Khabarovsky Krai – 2020

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The UConn Geriatric Psychiatry Fellowship Program is committed to actively fostering well-being for our trainees as well as our faculty. We do this by providing a culture of support, cultivating growth, recognizing that we all make mistakes, and supporting each other during difficult periods.

Our fellowship wellness activities include:

• A program sponsored wellness day/activity
• Fitness Challenge
• Annual holiday party
• Annual graduation celebration event
• Protected vacation time
• Individual mentorship and career guidance
• Instagram: @uconngeripsych
• Facebook: UConn Geriatric Psychiatry Fellowship
• GME benefits including parental leave, health benefits, Employee Assistance Program, Education funds, and discounts
• Our trainees and faculty truly enjoy each other’s company. We often find well-being outside of work, and participate in activities together such as picnics, walks and hikes, celebrating each other’s special moments, and frequently sharing funny texts and memes!

UConn School of Medicine Graduate Medical Education is committed to supporting the well-being of all our residents and fellows during their training program. For a full list of resources offered through UConn Health, the Capital Area Health Consortium and the broader community, please visit the Graduate Medical Education Office  Well-Being website .

Latitude and longitude of Khabarovsk

Khabarovsk, khabarovsk krai (russia) latitude longitude.

• Khabarovsk Khabarovsk Krai Russia Latitude & Longitude
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• Where is Khabarovsk Khabarovsk Krai?

What is the latitude and longitude code of Khabarovsk? The latitude of Khabarovsk, Russia is 48.48271000, and the longitude is 135.08379000. Khabarovsk is located at Russia country in the states place category with the gps coordinates of 48° 28' 57.756'' N and 135° 5' 1.644 E. Geographic coordinates are a way of specifying the location of a place on Earth, using a pair of numbers to represent a latitude and longitude. These coordinates are used to indicate the position of a point on the surface of the Earth, with the latitude representing the distance north or south of the equator and the longitude representing the distance east or west of the prime meridian. By using these coordinates, it is possible to pinpoint the exact location of a place on the globe.

🧭   GPS coordinate of Khabarovsk, Russia

Here you will find the GPS coordinates and the longitude and latitude of Khabarovsk . Coordinates of Khabarovsk, Russia is given above in both decimal degrees and DMS (degrees, minutes and seconds) format. The country code given is in the ISO2 format. Are you a resident of Khabarovsk, Russia? We're looking to verify and update our data. If you notice any inaccuracies or outdated information, please let us know .

🗺️   UTM coordinate of Khabarovsk, Russia

Khabarovsk, Russia, is precisely mapped in the UTM coordinate system, located in zone 53U. Its UTM Northing coordinate is 5374547.3351284, and the UTM Easting coordinate is 727869.48436195, providing a detailed and specific location within the global grid. Additionally, Khabarovsk's location is encoded as z085cfj022nq in the GeoHash system, a compact representation that is useful for various geospatial applications. These coordinates offer an accurate and efficient way to pinpoint Khabarovsk's exact position for mapping and navigation purposes.

📍 Where is Khabarovsk, Russia on Map Lat Long Coordinates?

Where is Khabarovsk, Russia, location on the map of Russia ? Khabarovsk is located in Russia country, in Europe continent (or region). Exact geographical coordinates, latitude and longitude 48.48271000, 135.08379000. Mapped location of Khabarovsk, Russia (N 48° 28' 57.756", E 135° 5' 1.644"). Khabarovsk is located in the time zone GMT+11.

Khabarovsk Krai has 40 cities. Currency in use in Khabarovsk is Russian Ruble (RUB) and to make an international call to this city, you must first dial the country code +7. Current local time in Khabarovsk, Russia .

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