By Selma Al-Samarrai

The Geriatric Psychiatry Clinic is part of a multidisciplinary program, The Regional Geriatric Program of Toronto, that has been housed at Providence Healthcare since 1988. The program has always been a collaboration of geriatric medicine and geriatric psychiatry with the understanding that chronic medical or psychiatric illnesses contribute to frailty in the elderly. A critical component of the program is the outreach service which involves health care professionals visiting patients’ homes to identify psychosocial and functional stressors that likewise contribute to frailty. The current team includes two geriatric psychiatrists, two geriatricians, a home-visiting general practitioner, a registered nurse, social worker, physiotherapist, two occupational therapists, and an administrative assistant.

The mandate of the program is essentially the assessment and treatment of frail older adults.The psychiatry clinic evolved as a significant partner with geriatric medicine because co-morbid mental illnesses, neurodegenerative disorders – such as dementia, and psychosocial stressors are significant problems for the elderly, more-so than chronic medical illness. The geriatric psychiatry clinic gets referrals primarily from family physicians in Providence’s catchment area but also from geriatricians and neurologists if their patients are presenting with symptoms suggesting the diagnosis of a psychiatric disorder that falls outside a physician’s area of expertise, or, most often, there are symptoms associated with a neurodegenerative disorder requiring the attention and treatment by a psychiatrist.

Geriatric psychiatrist Dr. Ian Ferguson among the physicians to visit patients in the community

The role of the clinic’s geriatric psychiatrists is to then assess, consult, and treat geriatric patients who may have a mental health issue, dementia syndrome, behaviour disorder, or a psychosocial problem. Symptoms that patients with dementing illnesses present with, that are of concern and may require long-term management and treatment, are described as “non-cognitive” and include: paranoia, disturbances of mood, hallucinations, misidentification phenomena, and disturbances of behaviour. These symptoms contribute to significant impairment of function and compromise interpersonal relationships. Education about these symptoms is part of the treatment offered by the geriatric psychiatrists. The more families and caregivers understand about symptoms associated with an evolving dementia, the more the use of psychoactive medications can be minimized.

Most of the patients coming to the clinic are seen in the community by one of the occupational therapists prior to their appointment. The occupational therapist does a cognitive screen and preliminary appraisal of the social circumstances in which the patient lives. The geriatric psychiatrist is able to then use this information when offering treatment options after a diagnosis has been established. The recommended treatments vary depending on the patient’s diagnosis, symptoms, and circumstances.A referral to the social worker is invaluable. The social worker visits the patient at home to discuss any problems they are encountering, and may make recommendations including programs that are available for the patient and their family in their community.

One of the geriatric psychiatrists sees housebound patients in their homes and the other geriatric psychiatrist does consultation liaison psychiatry on our Rehab Units at Providence. As more patients are choosing to remain at home for the duration of a dementing illness, there is an increasing need for community involvement like the one done by this program.