Integrated Community Collaborative Care for Seniors with Depression/Anxiety and any Physical Illness

  • Richard Shulman Trillium Health Partners, University of Toronto
  • Reenu Arora Trillium Health Partners
  • Rose Geist Trillium Health Partners, University of Toronto
  • Amna Ali Trillium Health Partners
  • Julia Ma Trillium Health Partners
  • Elizabeth Mansfield Trillium Health Partners, University of Toronto
  • Sara Martel Trillium Health Partners, University of Toronto
  • Jane Sandercock Trillium Health Partners
  • Judith Versloot Trillium Health Partners, University of Toronto
Keywords: seniors, mental health, collaborative care, integrated care, depression, anxiety, psychotherapy, chronic illness

Abstract

Background

We report on the feasibility and effectiveness of an integrated community collaborative care model in improving the health of seniors with depression/anxiety symptoms and chronic physical illness.

Methods

This community collaborative care model integrates geriatric medicine and geriatric psychiatry with care managers (CM) providing holistic initial and follow-up assessments, who use standardized rating scales to monitor treatment and provide psychotherapy (ENGAGE). The CM presents cases in a structured case review to a geriatrician and geriatric psychia­trist. Recommendations are communicated by the CM to the patient’s primary care provider.

Results

187 patients were evaluated. The average age was 80 years old. Two-thirds were experiencing moderate-to-severe depres­sion upon entry and this proportion decreased significantly to one-third at completion. Qualitative interviews with patients, family caregivers, team members, and referring physicians indicated that the program was well-received. Patients had on average six visits with the CM without the need to have a face-to-face meeting with a specialist.

Conclusion

The evaluation shows that the program is feasible and effect­ive as it was well received by patients and patient outcomes improved. Implementation in fee-for-service publicly funded health-care environments may be limited by the need for dedicated funding.

Author Biographies

Richard Shulman, Trillium Health Partners, University of Toronto

Division of Geriatric Psychiatry, Department of Psychiatry, Faculty of Medicine

Rose Geist, Trillium Health Partners, University of Toronto

Department of Psychiatry, Faculty of Medicine

Amna Ali, Trillium Health Partners

Institute for Better Health

Julia Ma, Trillium Health Partners

Institute for Better Health

Elizabeth Mansfield, Trillium Health Partners, University of Toronto

Institute for Better Health, Faculty of Occupational Science and Occupational Therapy

Sara Martel, Trillium Health Partners, University of Toronto

Institute for Better Health, U Institute of Communication, Culture, Information, & Technology

Jane Sandercock, Trillium Health Partners

Institute for Better Health

Judith Versloot, Trillium Health Partners, University of Toronto

Institute for Better Health, Institute for Health Policy, Management, & Evaluation

Published
2021-07-13
How to Cite
Shulman, R., Arora , R., Geist, R., Ali, A., Ma, J., Mansfield, E., Martel, S., Sandercock, J., & Versloot, J. (2021). Integrated Community Collaborative Care for Seniors with Depression/Anxiety and any Physical Illness. Canadian Geriatrics Journal, 24(3), 251-257. https://doi.org/10.5770/cgj.24.473
Section
Clinical Practice Guidelines/Consensus Statements