Comparison of the Management of Depression and Dementia in Older Adults in Primary Care and Geriatric Specialty Clinics in the Roanoke Valley

Introduction: Many problems prevalent in the geriatric population, such as dementia and depression, have traditionally been treated in the primary care setting, only being referred to a geriatric specialist when it is considered to be more advanced. While this does have benefits and improves access to healthcare, it presents challenges of its own and there has been a push to improve coordination between mental health and primary care. It has been noted that depression and early stage of dementia are often undiagnosed or inadequately treated by non-psychiatric or non-geriatric specialties. Primary care physicians may not be as likely to prescribe the full range of available or approved medications, or may not be comfortable with higher doses of psychiatric medications for example. There may also be a delay in appropriate referral of these patients to a specialist that could affect the outcome for these patients on the long run. Therefore, not only medical professions, but also patients call for integration of mental health and primary care to reduce the fragmented and inadequate care of mental health problems in primary care patients. Methods: We would like to use the electronic medical records from Carilion Roanoke Memorial Hospital, one of the largest hospitals in Virginia, to gather data on patients with such illnesses who are being followed by primary care, geriatric psychiatry, and geriatric medicine and to compare the pharmacological interventions. Statistical analysis including Statistical Distributions, ANOVA, T tests, and Chi-squared test are applied to analyze the patient’s diagnosis, treatments and the prognosis of about eight thousands geriatric patients in the database, in which, the patients are classified according to gender and age groups including 60-70 years old, 70 to 80 years old and over 80 years old. The differences in diagnosis interventions, treatment plan, psychotropic medication applications and dosing, as well as the long-term prognosis of depression and dementia in the geriatric population in the Roanoke Valley area are compared. Results: The preliminary data shows that benzodiazepines, particularly clonazepam and alprazolam, are the most often prescribed sedatives by primary care in treating depression or dementia with behavior disturbance. These medications have significant adverse effects, such patient falls and worsening dementia, therefore, significantly increase morbidity in geriatric patients. Preliminary data also shows that it is common for drugs to be prescribed under the effective dose for the illness. In addition, because of the lack of experience in diagnosis illness using the latest criteria and scales, patients in primary care then to have high rates of under diagnosis of dementia and depression. Conclusions: With our findings, we hope to emphasize the importance to improve care integration between psychiatry and primary care so that patients will be treated with appropriate medications at the appropriate time, as well as have appropriate and timely referrals to geriatric psychiatry when needed.