LUCY SCHULTZE

For Dr. Marshall Belaga, caring for senior citizens with psychiatric illnesses doesn’t end when they leave his inpatient center.

At check-out, the medical director of Rankin Medical Center’s Senior Care Program spends some 15 minutes writing out a discharge summary for each patient in order to provide continuity in care.

“It takes that long because I try to go over every aspect of their medical and psychological care,” he explained. “We make an effort to send out the discharge summary to everybody who’s involved in that individual’s care — whether it’s their family, a nursing home, their psychiatrist or family physician.”

Taking a thorough approach to the discharge summary is just one way the Senior Care Program staff aims to buffer the transition between inpatient care and the more independent life many of its patients return to. An average stay in the 15-bed geriatric psychiatric unit is 10 days.

Under Belaga’s lead as medical director since 2003, the program has also been focused on treating the caregiver as well as the patient themselves, particularly those caring for patients of dementia illnesses.

“In the older days of psychiatry, we didn’t deal with a family but with an individual,” he said.

There have been enough studies, though, that show the toll such a lifestyle can take among caregivers of Alzheimer’s patients, who are usually the patient’s spouse or child and are usually female.

“There’s a significant increase in morbidity and mortality in caregivers,” Belaga said. “Because we recognize that, I personally meet with every caregiver once a week with our social worker and nurse.”

During those sessions, the team identifies the symptoms of stress in the caregiver’s life, including changes in his or her diet, anxiety and sleep levels.

“We also get a chance to observe how they interact with their loved one and can give tips,” Belaga said. “We try to address the entire social spectrum for these individuals.”

A part of what makes a broad approach more natural is being in a hospital setting, he said. That means the Senior Care Program can facilitate MRIs and tests for cardiac and pulmonary diseases, to rule out those things as culprits in the patient’s current problem.

“For depression in the elderly, you may find out they actually have sleep apnea and that may explain 85 to 90 percent of the symptoms,” Belaga said.

In that case, CPAP therapy to alleviate the sleep disorder is more appropriate than antidepressant medication, he said.

“As a psychiatrist, I try to figure out what is it besides their psychiatric problem that needs to be addressed,” he said.

For those patients who do need medications, Belaga is looking forward to the next generation of antipsychotics and antidepressants, which are expected to roll out in the next decade. Coming alongside them will be a new ability to genetically match drugs with the people who will best respond to them.

Currently, he said, some 20 percent of Caucasians have difficulty metabolizing the antidepressant drug Zoloft.

“A lot of times it won’t work for those people, and at this point we don’t have the clinical ability to easily test for that,” Belaga said. “But if you give it and it doesn’t work, it may be for a reason that has nothing to do with the depression itself.”

At Rankin Medical Center, the Senior Care Program also works to connect patients’ families with elder law attorneys, who can help families sort through the complicated systems of Medicare and Medicaid. Connecting with primary-care doctors is important, too — especially when it comes to monitoring patients before or after they reach the hospital.

Belaga recommends primary-care doctors find simple assessment tools online, such as the well-known clock-drawing test, to use in-office or send home.

“There are things you can do that are quick and easy, or you can have the patient and caregiver do it on their own,” he said. “This helps you monitor how the patient is doing over time.”

In addition to its inpatient service, the Senior Care Program is also aiming to launch an intensive outpatient program by the end of the year.



December 2007