Juliet A. Glover

Assessment of the person with late-life depression.

This article discusses characteristic factors in the presentation of depressive disorders in persons older than age 65 years. Clinical presentation is discussed along with risk and protective factors. Detailed descriptions of tests useful for screening and diagnosis of depression in the elderly are presented. Each test is reviewed according to time to administer, sensitivity and specificity, outcomes, advantages, and disadvantages. The importance of clinical history and the diagnostic interview, as well as the role of laboratory studies and neuroimaging in the clinical evaluation are discussed.

Introduction to Telepsychiatry

Technological advances have been applied to the practice of medicine including psychiatry. One such application is the growth of telepsychiatry. Telepsychiatry can be defined as the use of two-way interactive videoconferencing technology to provide mental health and substance abuse services remotely. Telepsychiatry falls under the umbrella terms such as telemedicine and telehealth. Telepsychiatric implementations date back to the 1950s when closed circuit television was utilized as a teaching tool. This technology was subsequently applied to the provision of group psychotherapy. In 1973, the term telepsychiatry was coined. While it improved access to care, it was costly to implement. With continued technological advancements in the 1980s and on, not only did cost begin to decrease but also the quality of the audiovisual technology improved. Since then, this treatment modality has been applied to a variety of populations from children to geriatric patients. It has been applied in various settings including hospitals, outpatient clinics, long term care facilities, and correctional settings. Lastly, it can be utilized for education of staff and trainees, coordination of the treatment team, and direct patient care.

Overview of Telepsychiatry in Geriatrics

As the American population continues to age, innovative methods of addressing healthcare needs are necessary. Mental illness is prevalent in geriatric patients including depressive, anxiety, and neurocognitive disorders. There is a shortage of specialty trained geriatric psychiatrists to meet the mental healthcare needs of older adults which can be further magnified for those patients residing in less populated areas. One way to meet this growing need is geriatric telepsychiatry. Telepsychiatry has the potential to not only increase access to mental healthcare for underserved older adults, but also decrease cost of providing care. The current literature demonstrates that geriatric telepsychiatry can be reliably utilized to diagnose and treat mood, anxiety, substance use disorders, and other psychiatric illnesses in older adults. It can be used to administer cognitive screening tools and neuropsychological testing. Furthermore, outcomes are equivalent to in-person care with regard to symptom improvement and treatment adherence. Patient and provider satisfaction is generally high even in geriatric populations. While some older adults may present challenges in utilizing telepsychiatry including vision, hearing, and cognitive impairment, measures can be successfully implemented to overcome these challenges.

PSYCHIATRIC FACE TIME: TELEHEALTH FOR TECHNOLOGY-DRIVEN INNOVATIONS IN DEMENTIA CARE

this information two methodologies will be used: a semistructured interview and a participant observation. The interview will be administered to those people in the early stages of the dementia at home. Interviewees will be asked to explain the compensations they are using to carry out instrumental activities of daily living where they have limitations. Information will be retrieved on for how long they have been using them, the satisfaction these strategies provide and where they got it from. Demand of additional help will be asked. Several sociodemographic and type of dementia and severity variables will be retrieved. In the participant observation carried out at the individuals’ home, information will be retrieved on the sequence in whichthe actions aredeveloped; technical aids used influence of the home environment on the process and its outcome. Up to now, the observational stage has started and some results have been collected. The collection of this information will allow the professionals to: (1) understand the real needs and difficulties of the people with dementia; (2) design and validate more ecological interventions based on the concept of everyday live and which will be able to maximize their capacities to meetthechallenges of their lives.