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Haley E. Curt, Psy.D., is a 2020 graduate of the Psy.D. Program in Clinical Psychology at Antioch University, New England

Dissertation Committee:

  • F. Alexander Blount, EdD, Committee Chair
  • Aimee Valeras, PsyD, Committee Member
  • Amanda Hitchings, PsyD, Committee Member

Keywords

quality improvement, integrated behavioral health, primary care, older adults, cognition, memory

Document Type

Dissertation

Publication Date

2020

Abstract

Integrated care, a combination of medical and behavioral health, is necessary to address the complex needs of the rapidly growing population of adults over the age of 65 (Karel, Gratz, & Smyer, 2012). Cognitive impairment, a common issue associated with aging, is a major concern for aging adults, their caregivers and family members. Comprehensively addressing cognition, whether there is an identified impairment or not, in a primary care setting allows the individual to take advantage of their independence, be an active member of planning care and making decisions, and begin treating their disease earlier when it is more manageable (Callahan et al., 2006). This project was designed to address concerns for all older adults and to offer the potential impact of psychosocial support in relation to memory and cognition during the Medicare Wellness Visit (MWV). The goal was to gain further information from patients about their memory concerns, appreciate how this related to their score on a validated test of cognitive functioning, and provide more comprehensive care. A behavioral health clinician offered a 30-minute visit that provided the patient/family with concern specific information, tools, and strategies. Eighty three percent of eligible patients accepted the behavioral health component of their MWV. Of this group, 30% of patients had a positive (atypical) score on the Montreal Cognitive Assessment (MoCA), but 100% expressed concerns with their memory and cognition. These concerns included forgetfulness, distractibility, the associated frustration, and the need for tools and strategies to assist with functioning. All patients (100%) who accepted the BHC component of their MWV were followed up with two weeks later to gather information about perceptions and reactions to having their memory concerns addressed through an integrated care approach. Patients reported it was helpful to discuss topics including typical versus atypical aging, focus and concentration, mentally stimulating activities, and reducing distractions. These results indicate that an integrated care approach to address memory concerns in older adults during their annual MWVs, regardless of MoCA score, had a positive impact on patient's quality of whole person care and indicate support for a system wide integrated approach to older adult primary care.

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Haley E. Curt

ORCID Scholar ID# 0000-0003-4594-8738

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