The graying of integrated health: the specialized role of psychology in geriatric primary care

Abstract

Objectives

Integrating behavioral health services into primary care is an important global initiative to improve access to mental health services. Within the Veterans Health Administration (VHA), Geriatric Patient Aligned Care Teams (GeriPACTs) are one model of integrated care for frail older adults to serve older Veterans with geriatric syndromes and increased probability of cognitive impairment. Understanding of the role of psychology in GeriPACT is limited. This study examines this role, describes the practice of these psychologists, and evaluates the integration of psychology into geriatric primary care.

Methods

A mixed-methods design was used. Recruitment occurred through two VHA listservs for GeriPACT and Primary Care Mental Health Integration (PC-MHI) psychologists. Surveys examined referral processes, service access, clinical services provision, and use of psychotherapy modalities. Twenty psychologists participated. Structured follow-up interviews were conducted with five participants.

Results

A large minority of psychologists did not have FTE allotted for GeriPACT work they provided (40%). Sixty percent were assigned to one GeriPACT team. Twenty percent served four to seven GeriPACT teams. Eighty percent provided same-day services. Cognitive assessment was provided weekly by over sixty percent of providers who had FTE allotment to this role. Qualitative data provided a rich description of psychologists’ perceptions of their role, team functioning, referral processes, visit structure, and other factors.

Conclusion

Findings are discussed in the context of the World Health Organization’s guidelines for integrating mental health into primary care. Data suggest a need for an integrated model that adapts to the special needs of older adults in primary care.

Keywords:

• GeriPACT
• veterans
• mental health

Acknowledgements

All of the authors of this article are employees of the Department of Veterans Affairs; however, the opinions, findings, and conclusions expressed in this article are those of the authors and not necessarily those of the Department of Veterans Affairs. We would like to thank the following colleagues for their generous support throughout the process of developing this article: Michele J. Karel, Jennifer Moye, and Jennifer Sullivan. We would also like to acknowledge those psychologists who responded to our recruitment call and provided us with rich details about their clinical duties within geriatric primary care. In many cases, their contributions to this specialized population go under-recognized, clinically and administratively, and are sustained by passion and commitment to aging populations. Lastly, we acknowledge that our work addresses a model of integrated care for a subset of vulnerable older adults and does not highlight the vast majority of older adults who are aging gracefully devoid of chronic health problems and with whom we might never interact within our clinical roles.

Disclosure statement

No potential conflict of interest was reported by the author(s).