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

Richard Shulman; Reenu Arora; Rose Geist; Amna Ali; Julia Ma; Elizabeth Mansfield; Sara Martel; Jane Sandercock; Judith Versloot

doi:10.5770/cgj.24.473

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

Can Geriatr J. 2021 Sep 1;24(3):251-257. doi: 10.5770/cgj.24.473. eCollection 2021 Sep.

Authors

Richard Shulman^{1

2}, Reenu Arora¹, Rose Geist^{1

3}, Amna Ali⁴, Julia Ma⁴, Elizabeth Mansfield^{4

5}, Sara Martel^{4

6}, Jane Sandercock⁴, Judith Versloot^{4

7}

Affiliations

¹ Trillium Health Partners, Mississauga, ON, Canada.
² Division of Geriatric Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
⁵ Faculty of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
⁶ U Institute of Communication, Culture, Information, & Technology, University of Toronto, Mississauga, ON, Canada.
⁷ Institute for Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada.

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.

Keywords: anxiety; chronic illness; collaborative care; depression; integrated care; mental health; psychotherapy; seniors.