McLean Hospital 115 Mill Street Belmont, MA 02478
With the August 2015 launch of the Center of Excellence in Geriatric Psychiatry, the hospital completed its strategic goal of fully integrating patient care, research, and educational activities into seven programmatically-based centers.
We sat down with the new center’s chief, geriatric psychiatrist Brent P. Forester, MD, MSc, to talk about his goals for the future.
Horizons: What are some of the center’s early accomplishments?
Dr. Forester: Until now, the different components of the geriatric psychiatry program—clinical care, research, and training—have been somewhat siloed. We are now coming together for monthly meetings to learn from each other. For example, the research program is often trying to recruit patients for clinical studies, but previously clinicians weren’t always aware of the opportunities to participate in our research. Clinicians will notice things about patients’ symptoms or how they’re responding to a specific treatment that can inform questions we address through research.
There’s still so much to learn about older people and mental illness. Our treatment decisions are guided by our clinical intuition and what we know from the literature. Yet, many of the studies we rely upon have not included older adults with complex medical issues similar to those we are actually treating. The depression we see in a 75-year-old man with diabetes and heart disease who has recently lost his spouse and is becoming increasingly confused is unlike the depression of a 35-year-old with different stressors. If clinicians and researchers aren’t talking with each other, we’ll miss opportunities to try out new ideas and study them in ways that yield better treatments for older people.
Horizons: Is there anything new on the horizon for the center?
Dr. Forester: We recently hired a medical director for our geriatric psychiatry outpatient programs. Ipsit Vahia, MD, is a young, nationally renowned geriatric psychiatrist from the University of California, San Diego, who will help us to integrate research more formally into our outpatient programs. Dr. Vahia’s research focuses on the use of mobile technology—like fitness tracking devices—to better learn about our patients during the many hours that they’re not with us. There is a lot of basic data we can collect about their behaviors, including activity level and sleep patterns, that can inform both diagnosis and treatment.
Horizons: Do you have ideas for other new initiatives?
Dr. Forester: A new direction for us, which is very much in the gestational stages, is the area of healthy brain aging. Many baby boomers worry about their memory and risk of Alzheimer’s dementia. There’s a growing body of data around techniques to help reduce the risk of Alzheimer’s, many of which are nonmedical interventions such as exercise, brain stimulation, or nutrition. Instead of waiting for people to come to us already sick, we would reach out to people while they’re still functioning well to help slow down or delay cognitive decline.
I’m also excited about new developments in our Memory Disorders Assessment Clinic, which specializes in the evaluation and treatment of individuals with mild to moderate memory impairment. Many of our patients also have complex medical issues that impact brain function. We coordinate with outside medical doctors, of course, but it’s not an integrated operation. We’ve recently hired a geriatrician, Dr. Lara Terry, who will join our Memory Disorders Assessment Clinic and evaluate patients with complex medical problems. She’ll help us determine how medical issues—including medications—may be contributing to any psychiatric or cognitive problems and collaborate with the rest of the team to deliver coordinated care.
We are also adding social work expertise to our team. In the past, when families had questions about things like legal matters, day treatment programs, long-term care, or managing behavioral symptoms, we did not have a clinician to provide education and support to families or to coordinate referrals to community programs. Thanks to a generous grant from the George Frederick Jewett Foundation East, we will be piloting the use of geriatric care consultants to round out our services. They’ll meet with families, run support groups, and connect them to community resources, including those available through our local chapter of the Alzheimer’s Association.
Horizons: What role has philanthropy played in the division?
Dr. Forester: To put it simply, our research program exists because of philanthropy. For instance, generous support from the Merrill family through The Andrew P. Merrill Memorial Research Fellowship has enabled McLean junior faculty member Jennifer R. Gatchel, MD, PhD, to conduct novel research into brain circuitry. It means that promising researchers like Dr. Gatchel don’t have to abandon a career in clinical research because of a lack of funding. And we’ve also been able to leverage the research supported by philanthropy to attract more sources of funding from the National Institutes of Health and private industry.
Philanthropy also helps us build outpatient capacity—our new dementia care consultants are a good example of this—so we can keep people at home, relatively independent and delay or avoid transitions into long-term care settings. Health insurance doesn’t cover important aspects of coordinated treatment, so philanthropy is critical for such resources.