Geriatric Mental Health Alliance News - Week of February 23, 2009

Geriatric Mental Health Alliance News

A bi-weekly email to brief you on issues important to geriatric mental health

February 23, 2009 - Vol 3, Issue 02

GMHA Budget Recommendations

In response to the Governor's proposed budget, The Geriatric Mental Health Alliance calls for the Legislature to:

• Add $1 million for geriatric mental health and/or addictions demonstrations
• Reject cuts to home care and to community-based services funded through OFA
• Insure that new federal stimulus funds that are designated for health care be used for that purpose
• Reject the proposed cut of the state share of SSI
• Reject the 1% cut to base funding for mental health and aging services
• Reject deferral of scheduled cost of living adjustments
• Provide full funding for advocacy services in adult homes and nursing homes, such as those provided by the Coalition of Institutionalized Aged and Disabled and the Long Term Care Ombudsman Program
• Continue funding for EPIC and Medicaid to cover medications not covered by Medicare
• Reject the proposal to add anti-depressants to the Medicaid preferred drug program and insure full access to all mental health medications
• Reject the proposal for NYS Psychiatric Center Directors to serve as representative-payees for hospital patients
• Reject cuts to continuing day treatment programs, some of which serve older adults with serious mental illness.
• And more

For more information about GMHA's budget recommendations, click here to read our two-pager about the budget.

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GMHA Calls for Behavioral Health and LTC Act

GMHA is pressing for the Legislature to pass a Behavioral Health and Long-term Care Act to force the state to address mental and behavioral disorders that contribute to avoidable instances of institutionalization. A large proportion of older adults receiving, or in need of, long-term care in New York State have diagnosable behavioral disorders, however their behavioral health needs and those of their family caregivers are not adequately addressed in NYS's long-term care system. Long-term care restructuring cannot be effective without confronting these disorders. The Act begins to address the interface between behavioral health and long-term care. The Act calls for:

• Establishing a Long-term Care Subcommittee of the NYS Interagency Geriatric Mental Health and Chemical Dependency Planning Council to examine NYS's current long-term care reform initiatives, develop recommendations and a plan to build in appropriate measures related to behavioral health, and promote public-private partnerships.
• Expanding and/or sets aside Nursing Home Diversion Slots to include people with mental or substance use disorders
• Requiring "New York Connects" and similar long-term care information and assistance services to have adequate resources to respond to people with mental or substance use disorders.
• Requiring the NYS Department of Health and the Office for the Aging in consultation with the Departments of Mental Hygiene to review and make necessary modifications to their training requirements in long-term care, to provide technical assistance to community-based long-term care providers regarding geriatric behavioral health and to work with professional schools to enhance curricula regarding behavioral health and long-term care.

Click here to read a full draft of the Act.

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Dawn Lannon of the NYS OMH Receives GMHA Leadership Award

On February 06, 2009, at GMHA's annual meeting, Dawn Lannon, Associate Commissioner for the Adult Community Care Group at the NYS Office of Mental Health received the GMHA Leadership Award for her critical contributions to geriatric mental health in NYS. She was instrumental in the negotiations that led to the passage of The Geriatric Mental Health Act and has provided strong, ongoing leadership regarding geriatric mental health in the Office of Mental Health. She has been a great force for progress.

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GMHA Upcoming Events

March 4, 2009 - GMHA Substance Abuse Workgroup Meeting

Location: UJA Federation of New York, 130 E 59th St, Room 706/708
Time: 1:00-3:00pm

The purpose of the workgroup is to develop a position paper on the needs of older adults with substance abuse problems. We hope you will be able to join us.

If you plan to attend, please RSVP to Abby Marquand at amarquand@mhaofnyc.org.

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March 5, 2009 - The 12th Annual Comprehensive Approach to Dementia Symposium: A Practical Update for Practitioners in Mental Health, Primary Care and Long-Term Care Settings.

Location: New York Academy of Medicine, 103rd Street at 5th Avenue, NYC

This course will offer the practitioner an overview of emerging trends in the diagnosis and treatment of the dementias. A nationally recognized faculty will discuss the characterization and treatment of the cognitive, behavioral and psychological signs and symptoms of dementia.

GMHA members attend for $25 but need to register in advance.

For more information, click here or http://www.mhaofnyc.org/yusyin/AGENDAsansAddresses.doc

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March 31, 2009 - Symptoms of Paranoia Among Older Adults: A Best Practices Presentation in Geriatric Mental Health co-sponsored by the Geriatric Mental Health Alliance of New York and the Brookdale Center for Healthy Aging and Longevity of Hunter College.

This presentation will give an overview of the symptoms of paranoia which may occur among older adults with mental health needs. Topics to be covered include: differential diagnosis, best practices in clinical treatment and systems issues which can affect treatment outcomes. Examples of challenging cases and their management will be discussed.

The event will be held from 3:00 - 5:00PM at the Hunter College School of Social Work - Auditorium, 129 East 79th Street, NYC, (Between Lexington and Park Avenues). Please register by clicking here or visit: http://survey.constantcontact.com/survey/a07e2gqipy9frb0b4w4/start. If you have any questions, please email or call Yusyin Hsin at yhsin@mhaofnyc.org or (212) 614-6356. The event is free but pre-registration is required.

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May 15, 2009 - Save-the-Date - Third Annual Geriatric Mental Health Alliance Conference.

TREATMENT AND BEYOND: Meeting the Behavioral Health Challenges of the Elder Boom
Brooklyn Marriott, NY

Keynote Speaker: Cameron J. Camp, Ph.D.

Click here for the Save-the-Date Flyer.
Click here for the Sponsors/Vendors Prospectus

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GMHA Annual Report

GMHA has written an annual report documenting its work in 2008. It was a year of considerable activity and a number of noteworthy achievements. GMHA's membership grew to over 3000 members. GMHA's advocacy contributed to important policy developments in New York including regulatory changes that open the door to expanding mental health services for older adults, continued funding of the NYC Council Geriatric Mental Health Initiative, and the growth of local geriatric mental health alliances.

GMHA has also expanded its educational activities with another successful annual conference, another lecture series on best practices, training programs on clinical practice and on how to finance services, a tool kit on how to organize geriatric mental health advocacy, a bi-weekly newsletter, and steps towards the creation of a geriatric mental health training and technical assistance center without walls.

To read the full report, click here.

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Other Upcoming Events

March 04, 2009 - Navigating Medicare Part D Appeals: Helping Clients Get The Most Out Of Their Drug Plan

The Medicare Rights Center is offering a training for professionals to help people with Medicare get the most out of their prescription drug coverage. In the 2 hour training, topics such as the following will be covered: What is the Medicare drug benefit?, An overview of the Part D appeals process., How to appeal a Part D denial., Tips for success, and Follow-up steps after winning an appeal.

The event will be from 9:30 - 11:30am, at 520 Eighth Avenue (between 36th and 37th), 4 North

Fee: $35 per person

Click here to register online.

For more information or to register by phone, please contact Chinwe Nwosu at 212-204-6217 or cnwosu@medicarerights.org.

March 18-22, 2009 - Allied Team Training for Parkinson (ATTP) The National Parkinson Foundation, Inc is pleased to announce its signature educational program for health care professionals and students. Allied Team Training for Parkinson is a unique, comprehensive interdisciplinary training program where over 4.5 consecutive days, participants will learn:

• Key symptoms and treatment approaches for early, middle, and late stage Parkinson disease
• Specialized assessment and care techniques specific to their profession
• How to participate in interdisciplinary health care teams by practicing in teams
• Key concepts in health literacy and culturally responsive services

Click here for brochure.

Recognizing Medicaid Planning Opportunities at the Brookdale Center for Health Aging & Longevity With increasing longevity, the likelihood that most people will require medical intervention and supportive care at some point in the future has increased along with the potential for enormous medical bills and intense service needs. Financing these requires forethought and careful planning, including planning for Medicaid eligibility. This course provides information needed to raise these issues with clients and guidance on when to refer clients to an attorney specializing in elder law for sophisticated Medicaid planning. Medicaid planning strategies such as transfer of assets, spousal protections, home preservation, the use of trusts and avoiding liens and estate recoveries are discussed. Class runs over 5 sessions. Thursdays, February 26 - March 26 from 6:00 pm - 9:00 pm at the Brookdale Center for Healthy Aging and Longevity of Hunter College. (cost $450 for 5 sessions).

Click here for more information.

RRTI 2008-9 Geriatrics and Developmental Disabilities Nurse Training Program The Rehabilitation Research and Training Institute is pleased to announce the schedule for the 2008-2009 Geriatrics and Developmental Disabilities Nurse Training Program. For a full list of courses and their descriptions and registration, please visit www.rrti.org. Nurses with all levels of training are invited to register for these free courses. Please note that a certificate is available for those Nurses who complete C1-C4 and Nursing Contact Hours can be obtained. For more information and questions, please contact Matt Yaeger at matt@nyrehab.org or 518-449-2976 ext 101. Courses start September 17, 2008 at various videoconference sites.

This continuing education activity has been submitted to the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation

Educational Seminar Series at Service Program for Older People (SPOP) This training opportunity features SPOP clinicians who have extensive experience with older adults and mental health. It is offered to the professional geriatrics community and all who work with seniors. Each seminar is held at: 302 West 91st Street at West End Avenue, New York, NY. Seminar fee: $15. Discount for 3 or more attendees from the same organization. Space is limited. Please register in advance by mail or online at www.spop.org or call: 212-787-7120.

For topics, dates, and registration information, click here.

Consortium of New York Geriatric Education Centers
GNYGEC 2008/2009 is beginning another semester of Core and Elective trainings throughout the five boroughs. Click here for the 2008/2009 program announcement, registration form, credit card forms, and training locations. You may also register online here.

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NIA: Talking With Your Older Patient: A Clinician's Handbook

The National Institute on Aging (NIA) has released this comprehensive publication designed to enhance health care providers' communication with older patients. The overall aim is to introduce and/or reinforce communication skills essential in caring for older patients and their families. It suggests practical tips, techniques, and approaches to help with diagnosis, promote treatment adherence, make more efficient use of clinicians' time, and increase patient and provider satisfaction. Click here for the handbook.

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SPOP Receives National Award for Geriatric Mental Health Outreach Services

The Geriatric Mental Health Foundation (GMHF) and the American Association for Geriatric Psychiatry (AAGP) have selected SPOP to receive the first GMHF/AAGP Deirdre Johnston Award for Excellence and Innovation in Geriatric Mental Health Outreach Services. The Award Committee selected SPOP "for its dedication and exemplary service to Manhattan's older adults needing mental health services, including those who are homebound."

To read the full description of the award click here. For more information about services that SPOP provides in the home click here.

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Article...Health Care Costs Much Higher for Older Adults with Depression Plus...

Health Care Costs Much Higher for Older Adults with Depression Plus Other Medical Conditions

From National Institute for Mental Health
Science Update
February 13, 2009

Medicare participants who have diabetes or congestive heart failure as well as depression have significantly higher health care costs than their counterparts who do not have co-existing depression, according to a recent NIMH-funded analysis published online ahead of print January 16, 2009, in the Journal of the American Geriatric Society.

Background
Jürgen Unützer, M.D., MPH, of the University of Washington, and colleagues analyzed Medicare claims of 14,903 participants for a 12-month period between November 2004 and August 2006. The participants were enrolled in a pilot Medicare disease management program called Medicare Health Support, operated by Green Ribbon Health in Florida. The majority of participants had diabetes. Many had congestive heart failure. About 20 percent had both.

The researchers compared health care costs for three groups-

• 2,108 participants who had been diagnosed with depression,
• 1,081 participants not officially diagnosed with depression but who screened positive when given a questionnaire or who reported taking antidepressant medication, and
• 11,713 participants who did not have depression.

Results of the Study
Over one year, participants diagnosed with depression incurred about $22,960 in total health care costs, while those without depression incurred costs of about $11,956. Those with possible depression, based on depression screening or reported antidepressant use, incurred $14,365.

Participants with diagnosed depression spent significantly more in nearly every health care cost category, including home health care, skilled nursing facility costs, outpatient care, inpatient care, physician charges, and medical equipment. However, they did not spend more money on specialty mental health care compared to their non-depressed counterparts. Mental health care costs accounted for less than 1 percent of total health care costs.

Significance
The results indicate that among these Medicare beneficiaries with chronic medical illness, those who also have depression have significantly higher health care costs. Moreover, many in this high-risk group are not getting needed mental health care, the researchers said. The researchers theorize that the higher Medicare cost-sharing associated with outpatient mental health care-50 percent compared to 20 percent co-payments for medical services-may be a major obstacle to such care. In addition, older adults may be less likely to seek mental health care if they perceive a stigma associated with it. The researchers conclude by suggesting that improving mental health care for this population may help decrease overall medical costs.

What's Next
The results echo findings of other studies that have found health care costs tend to be higher for people in managed care situations who have depression. More research is needed to better understand the barriers to care, and efforts are needed to improve the quality and access to mental health care for older adults in managed care situations.

Reference
Unützer J, Schoenbaum M, Katon W, Fan M, Pincus H, Hogan D, Taylor J. Health care costs associated with depression in medically ill fee-for-service Medicare participants. Journal of the American Geriatric Society. Published online ahead of print Jan. 16, 2009. PMID: 19175438

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Article...Searching for Bobby Fischer...and Bobby Neugeboren

Searching for Bobby Fischer... and Bobby Neugeboren

By Jay Neugeboren
The Huffington Post, January 17, 2009

One year ago, on January 17, 2008, Bobby Fischer died in Reykjavik, Iceland, at the age of 64. In the fall of 1957, when Fischer and my brother Robert were both 14 years old and sophomores at Erasmus Hall High School in Brooklyn, they were in the school's chess club together. By this time, Fischer had become the youngest player ever to win the United States National Junior Chess Championship. Yet when Robert, who would spend most of his adult life, beginning shortly before his nineteenth birthday, as a mental patient, would try to get Fischer to play with him, Fischer would refuse. "'With you, Neugeboren, I don't play,' he always said to me," Robert says. Why not? "Because," Robert says, smiling, "he said I played crazy."

After winning the United States Junior Championship twice--he was 13 the first time--Fischer went on to become the youngest player ever to become a United States Master, the first and only player to win eight United States Chess Championships, the youngest player ever to become an International Master, and in 1972, at the age of 29, by his victory over the Russian grandmaster, Boris Spassky, in Reykjavik, Iceland, the first American-born player to become world champion.

Fischer also became famous through the years for his eccentricities, and, especially, for his pro-Nazi, anti-Semitic, and anti-American rants--for what Dick Cavett called Fischer's "gradual decline into [a] raving lunatic."

The parallels in the lives of my brother and Fischer are often as remarkable as they are sad, and I've tried here to tell part of the story:

Click here to read more.

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Article...Sensors Help Keep the Elderly Safe, and at Home

Sensors Help Keep the Elderly Safe, and at Home

By JOHN LELAND
Published: February 12, 2009

Increasingly, many older people who live alone are not truly alone. They are being watched by a flurry of new technologies designed to enable them to live independently and avoid expensive trips to the emergency room or nursing homes.

Bertha Branch, 78, discovered the power of a system called eNeighbor when she fell to the floor of her Philadelphia apartment late one night without her emergency alert pendant and could not phone for help.

A wireless sensor under Ms. Branch's bed detected that she had gotten up. Motion detectors in her bedroom and bathroom registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right. When she did not answer, that incited more calls - to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.

Technologies like eNeighbor come with great promise of improved care at lower cost and the backing of large companies like Intel and General Electric.

Click here to read more.

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Article...AHRQ: Use of Atypical Antipsychotic Drugs Increase Risk of Cardiac Death

Patients ages 30 to 74 who took atypical antipsychotics such as risperidone, quetiapine, olanzapine and clozapine had a significantly higher risk of sudden death from cardiac arrhythmias and other cardiac causes than patients who did not take these medications, according to a new study funded by the Department of Health & Human Services' Agency for Healthcare Research and Quality (AHRQ). The risk of death increased with higher doses of the drugs taken. The study is published in the January 15 issue of the New England Journal of Medicine.

Press Release: http://www.ahrq.gov/news/press/pr2009/antipsychpr.htm

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Article...Coffee Linked to Lower Dementia Risk

Coffee Linked to Lower Dementia Risk

By NICHOLAS BAKALAR
Published: January 23, 2009

Drinking coffee may do more than just keep you awake. A new study suggests an intriguing potential link to mental health later in life, as well.

A team of Swedish and Danish researchers tracked coffee consumption in a group of 1,409 middle-age men and women for an average of 21 years. During that time, 61 participants developed dementia, 48 with Alzheimer's disease.

After controlling for numerous socioeconomic and health factors, including high cholesterol and high blood pressure, the scientists found that the subjects who had reported drinking three to five cups of coffee daily were 65 percent less likely to have developed dementia, compared with those who drank two cups or less. People who drank more than five cups a day also were at reduced risk of dementia, the researchers said, but there were not enough people in this group to draw statistically significant conclusions.

Dr. Miia Kivipelto, an associate professor of neurology at the Karolinska Institute in Stockholm and lead author of the study, does not as yet advocate drinking coffee as a preventive health measure. "This is an observational study," she said. "We have no evidence that for people who are not drinking coffee, taking up drinking will have a protective effect."

Click here to read more.

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Article...Study Finds Risks With Newer Antipsychotics

Study Finds Drug Risks With Newer Antipsychotics

By BENEDICT CAREY and RONI CARYN RABIN Published: January 14, 2009

The popular drugs known as atypical antipsychotics, prescribed for an array of conditions, including schizophrenia, autism and dementia, double patients' risk of dying from sudden heart failure, a study has found.

The finding is the latest in a succession of recent reports contradicting the long-held assumption that the new drugs, which include Risperdal, Zyprexa and Seroquel, are safer than the older and much less expensive medications that they replaced.

The risk of death from the drugs is not high, on average about 3 percent in a person being treated at least 10 years, according to the study, published Thursday in The New England Journal of Medicine. Nor was the risk different from that of the older antipsychotic drugs.

But it was significant enough that an accompanying editorial urged doctors to limit their prescribing of antipsychotic drugs, especially to children and elderly patients, who can be highly susceptible to the drugs' side effects, including rapid weight gain.

In recent years, the newer drugs, which account for about 90 percent of the market, have become increasingly controversial, as prescription rates to children and elderly people have soared. Doctors use the drugs to settle outbursts related to a host of psychiatric disorders, including attention deficit disorder and Alzheimer's disease. Most are not approved for such use. After an analysis of study data, the Food and Drug Administration required that all antipsychotics' labels contain a warning that the drugs were associated with a heightened risk of heart failure in elderly patients.

The new study, an analysis of more than 250,000 Medicaid records, is the first to rigorously document that risk for the newer drugs in adults over 30 without previous heart problems.

Click here to read more.

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Article...Dementia More Likely in Some Isolated and Inactive Seniors, Study Finds

Dementia More Likely in Some Isolated and Inactive Seniors, Study Finds

By RONI CARYN RABIN Published: January 22, 2009

Attention, neurotic Woody Allen types: you really ought to get out more.

That's the latest news from researchers exploring whether people with certain personality traits are more likely than others to develop dementia. Past studies consistently have shown that worriers -who get stressed easily and are prone to anxiety and depression - are more likely to develop dementia later in life.

Now a new report from Sweden suggests that neurotics can shape their destiny to some extent, because lifestyle also plays a role. The study appeared on Tuesday in the journal Neurology.

Scientists at the Karolinska Institute in Stockholm followed a group of 506 people ages 78 and older who had no dementia at the beginning of the study. The subjects completed a personality questionnaire and were interviewed about their lifestyles, and then were monitored for several years, with medical exams at three years and again at six years.

After six years, 144 adults in the group had developed dementia. The researchers analyzed the accumulated data for possible associations between cognitive function, neuroticism and other characteristics, as well as lifestyle factors.

Very neurotic people were more likely to have developed dementia over time than were people who were calmer, more relaxed and self-satisfied, but only if they were also socially isolated and inactive, the researchers discovered. The subjects with all these risks were three times more likely to have suffered dementia compared to participants who were not neurotic but just as isolated and inactive, the study found.

Click here to read more.