Description 

Older adults living with severe mental illness represent a complex population due to comorbid acute and chronic medical conditions, cognitive impairment, decreased social supports and reduced financial resources. As a result, this population accounts for significant health care resources. For example, the Mental Health Commission of Canada revealed that adults 65 years and over with mental illness account for one-quarter of emergency department visits and hospital stays tend to be much longer for this population. Although there has been a shift towards developing community-based care in psychiatry, current models of care, such as adult assertive community treatment (ACT), have identified challenges in caring for older adults. In a study regarding practitioner’s perspectives of caring for older adults in general ACT teams, some of the key identified challenges included more physical health needs and difficulties providing geriatric-specific resources. As such, there has been increasing focus on developing interdisciplinary community outreach for older adults. Our session will introduce participants to two novel approaches to psychogeriatric outreach. We will begin by discussing an adaptation of ACT tailored to service older adults, psychogeriatric ACT. ACT has robust research examining model fidelity, therefore we will use fidelity tools, such as the Dartmouth Assertive Community Treatment Scale, to highlight key differentiating features of a psychogeriatric ACT team. We will explore the barriers and facilitators to implementing this novel approach to care. We will engage participants in a discussion about incorporating geriatric-specific care into mental health services. Next, we describe a novel psychogeriatric intensive case management team that provides support to homeless older adults experiencing mental illness, both with and without neurocognitive disorders. This team was designed to address a growing demographic in our urban centre. The team’s multidisciplinary structure will be described. The design of the program’s evaluation will also be outlined. We will proceed with a case-based discussion regarding complex medical, psychiatric and ethical presentations common in this population. We will share common challenges faced by community-based teams in providing services to older adults. Simulated vignettes will be used to teach colleagues how to manage these presentations effectively. One vignette will focus on an ethical discussion of elder abuse and capacity. The second will focus on intersectionality highlighting the interplay of homelessness, undertreated medical issues, barriers to service access, mental illness and substance use. Effective communication strategies and key lessons for management will be emphasized. The speakers in this session include two geriatric psychiatrists, with experience in developing novel approaches to geriatric outreach, and a resident with a research focus in this area.

Format 

Recorded webinar.

This content was recorded during the APA 2023 Annual Meeting.

Learning Objectives 

1. Identify challenges faced by general adult ACT teams’ in providing care to older adults.
2. Distinguish the core components of a geriatric ACT team from the traditional ACT team model, describing relevant barriers and facilitators to implementation.
3. Describe a novel, team-based program designed to support homeless older adults experiencing mental illness.
4. Teach and practice identifying and managing complex medical, psychiatric and ethical presentations in the geriatric population through simulated vignettes.

Target Audience 

Residents/Fellows, Psychiatrists, Psychologists

Estimate Time to Complete 

Estimated Duration: 1.25 hours
Program Start Date: May 1, 2025
Program End Date: May 1, 2028

How to Earn Credit 

Participants who wish to earn AMA PRA Category 1 Credit™ may do so after completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit  

In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

The APA designates this live activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Faculty and Planner Disclosures 

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity. 

Instructors 

• Sarah A. Colman, MD
• Michael Tau, MD
• Claire Stanley, MD
• Katherine Edmond, LPC

Planners  

• Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.

Accessibility for Participants with Disabilities 

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar. 

Technical Requirements 

This internet-based CME activity is best experienced using any of the following: 

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari 
• Internet Explorer 11+ 

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player. 

Optimal System Configuration: 

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version) 
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version) 
• Internet Connection: 1 Mbps or higher 

Minimum Requirements: 

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content 
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content 

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance