For Senior Citizens, a Laptop Becomes a Lifeline
WHY YOU SHOULD CARE
Because everyone needs a little help sometimes to be their best self.
When her patient mentioned the long, one-way commute he had taken to get to her office, Dr. Mary Lajoy, a psychiatrist in Portland, Oregon, began doing the mental math — nearly 150 miles, add in a stop or two, factor in the return trip — and the 50-minute appointment turned into an eight- or nine-hour journey. Lajoy’s patients, elderly veterans living in the rural Pacific Northwest, were spending the better part of a day traveling for what might need to be a monthly assessment. They couldn’t skip the medical care, but devoting a day to driving or navigating public transportation seemed to come with dangers too, especially for seniors. “As patients age, they may be dealing with pain or vision issues, or may need frequent stops,” says Lajoy.
For psychiatrists, medication management appointments like the ones Lajoy oversees are key to assessing how well treatments are working, reconsidering dosages and discussing any side effects. This is especially critical for elderly populations, says Lajoy, as their bodies may metabolize or react to medications differently than younger people, and they’re more likely to be managing multiple medications.
She and a colleague, Nathan Hantke, a board-certified clinical neuropsychologist at Oregon Health and Science University, conducted a pilot study to assess the efficacy of virtual visits. In this setup, patients would visit a local clinic, where they could connect via the internet with a virtual medication management appointment. “Instead of driving three hours, they might drive 10 minutes,” explains Lajoy.
Although the study was small — only about 40 people — the results were promising:
Ninety percent of participants said they were happy with or even preferred the virtual consultations.
“There’s this notion that we ran into that older adults would be skeptical of video, or would be intimidated by the technology, but our findings did not support the assumption,” says Hantke. When it came to telepsychiatry, seniors were excited for the option.
Hantke and Lajoy’s research confirms other findings that suggest telemedicine can offer quality and convenience to vulnerable populations like rural seniors, says Dr. Arpan Waghray, a geriatric psychiatrist and system director for behavioral medicine at Swedish Health Services and the chief medical officer of Well Being Trust. For example, a 2011 study from Canada found that 85 percent of patients and 92 percent of caregivers were comfortable or very comfortable during telehealth appointments — and the option reduced participants’ travel by more than 200 miles round trip. But even though seniors may be amenable to telehealth services, programs need to be implemented. A 2019 study conducted by Harris Poll of over 400 seniors found that 52 percent of seniors were willing to use telehealth services — but only 1 percent of seniors had ever had the opportunity for a telehealth visit.
Recognizing the need for accessible mental health support, health care provider Providence St. Joseph Health launched a pilot telepsychiatry program throughout Washington state in 2018. One element of the program is the ability to teleconference psychiatrists into general clinical care visits if a patient needs behavioral health care.
This is critical in Washington, as only 3 percent of the state’s 727 psychiatrists practice in rural areas — where nearly 14 percent of the general population lives. For one, while mental health resources are disproportionately centered around urban areas, rural residents need services just as much as their counterparts do. But studies have found that rural residents are less likely to recognize the need for mental health services, and stigma, accessibility and provider availability may further limit their options for behavioral health support.
And senior citizens, who may be vulnerable to brushing off mental health challenges as just another aspect of aging, can benefit from regular care and access to geriatric psychiatric specialists, says Waghray. “For our senior populations, we think about physical, psychological and social characteristics that may be impacting quality of life. One thing a mentor taught me, and I think about it a lot for the senior population, is instead of asking ‘what’s the matter with you?’ ask ‘what matters to you?’” says Waghray. “It’s a way to key into what a patient is living for, and what might be holding them back from an optimum quality of life.”
Telebehavioral health options give senior patients the ability to manage medication and mental health challenges — which can lead to a better overall quality of life, as well as a more positive health outlook. “Medical and mental health struggles are intertwined,” says Waghray. “For example, depression and pain do more than exist — they can cause each other and make each other worse.” But with a Wi-Fi connection, an understanding practitioner and access to mental health services, seniors can get on the road to wellness.