Home care

By Laura Moretz

WINSTON-SALEM, N.C. — Dr. Deidre Johnston, a psychiatrist with a specialty in geriatrics, would rather get in her car and see her patients in their homes than sit in her office at Wake Forest University Baptist Medical Center and wonder why they didn’t keep their appointments. Now she can do exactly that.

Arnold H. Snider of Princeton, N.J., is grateful to Dr. Johnston for visiting his mother at home when she needed psychiatric care. He wants more elderly people to have the same opportunity.

“Mr. Snider is a very perceptive man,” Johnston says. “He’s been concerned about the aging baby-boomer generation. Access to care for elderly people with depression is very poor. The system hasn’t made the leap necessary to bridge that gap.”

In honor of his mother, Snider and his wife Katharine have established an endowment to fund the Kate Mills Snider Geriatric Psychiatry Outreach Program at Wake Forest University Baptist Medical Center.

The goal of the program is to make sure elderly patients receive appropriate care — in their homes, if necessary.

Through the program, a few students in health-care programs at Wake Forest can get hands-on training in identifying and treating mental illness in geriatric patients.

Johnston, the program’s director, began working a few months ago with agencies that provide care to elderly people in Forsyth County.

The agencies all told her they recognized mental health was a missing piece in their services, she says.

Seeking out elderly people and addressing their mental-health issues just makes sense, Johnston says, noting that checking up on elderly patients in their homes is a normal practice Canada, Britain and Australia.

“Home visits are the gold standard of care for the elderly,” says Johnston, who trained in Ireland, where the emphasis is on outreach, and formerly was director of the Northern Alberta Regional Geriatric Program at the University of Alberta in Canada. “That model was the way I was brought up.”

As people age, she says, visits to doctor’s offices become increasingly difficult.

“It’s amazing we see as many people as we do in the office,” she says. “For as many as we see in the office, there’s many more that we are not treating.”

The program also educates health-care professional who already make home visits.

When a health-care professional recognizes signs of disorders such as depression or Alzheimer’s disease, Johnston says, early treatment can help the patient avoid hospitalization.

“As a person ages, particularly when frailty sets in, you’re never dealing with one issue,” she says.

A person with a chronic disease is more likely to suffer from depression as well. And elderly people with untreated depression are more likely to develop other medical conditions.

Even before depression becomes severe, the problem can be addressed.

“We’re going about it in a practical way,” Johnston says. “We may need to get someone out of the home to go to a social program a couple of days a week.

“We’ll also be working with primary care doctors. We’ll help manage homebound symptoms and disorders. As part of an interagency team, we’re trying to close the gap in care for these people.”

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