•  Geriatric Telepsychiatry
•  Ranna Parekh, M.D., M.P.H.

Telepsychiatry’s evidence base for geriatric telepsychiatry is substantial and outcomes have been positive in terms of satisfaction, validity/reliability, and preliminary clinical outcomes relative to in-person care.

• Satisfaction has been superior for patients, families, caregivers and providers.
• A variety of disorders have been effectively treated in this population, starting with depression in the late 1990s and extending to anxiety, dementia or cognitive impairment, and other difficult behavioral problems (e.g., agitation).
• Geriatric telepsychiatry has been primarily done to medical inpatient, primary care, and outpatient psychiatric settings.

The American Telemedicine Association Clinical Practice Guidelines discuss clinical, administrative, and technical issues for this population, including: determining patient appropriateness; site locations; therapeutic space; technology; reimbursement; and risk management.

Telepsychiatry considerations for geriatric patients are similar to those for adult patients, with a few key modifications:

• Pre-visit accounting of general events and the patient’s attitude, comments, complaints, sources of information, and clinician observations (e.g., olfactory/vision/hearing limitations, gait/balance problems) is helpful.
• The clinical examination may require staff assistance, particularly if a patient is delirious, combative, or agitated, or suffers from aphasia, poor hearing or vision impairment;
• The physical examination: camera control at the far end enables easy wide angle, close-up, and focused viewing to detect tremors, micrographia, and other psychomotor symptoms; however, staff may need to be trained to check for extrapyramidal side effects (EPS) like cogwheel rigidity.

Highlights or unique benefits of geriatric telepsychiatry include:

• As with standard care, family—particularly caregivers—are important to include, and they are extremely appreciative of services to help their loved ones. For technology-based interventions, some studies also show an improvement in quality of life and lessening depression.
• Teamwork: the clinician is part of an interdisciplinary team, a composite of outpatient allied mental health and social work professionals, primary care providers and others, all connected through telemedicine.
• Assessment, cognitive intervention, and outcome results have been similar to the in-person care.
• Nursing home and home outreach: many patients suffer without access to care and this is a very efficient way to deliver specialty expertise to them.

References

1. Rabinowitz T, Murphy KM, Amour JL, et al. Benefits of a telepsychiatry consultation service for rural nursing home residents. Tel e-Health. 2010;16(1):34-40.
2. Sheeran T, Dealy J, Rabinowitz T. Geriatric telemental health. In Telemental Health, Eds Myers K, Turvey CL. Elsevier, New York, NY, pp. 171-95, 2013.
3. Hilty DM, Ferrer DC, Parish MB, et al. The Effectiveness of telemental health: A 2013 review. Telemed J E Health 2013;(19):444-454.
4. Yellowlees PM, Shore JH, Roberts L, et al. Practice Guidelines for Videoconferencing-Based Telemental Health. Tel e-Health 2010;16(10):1074-89.