Our fellowship program consists of five, 10-week rotations at a variety of clinical sites. Longitudinal experiences in ambulatory care and nursing home care continue through all rotations. There is ample time during the year for fellows to complete electives, conduct research, and prepare for board certification examinations.
The Integrated Health and Aging Inpatient program at the UPMC Western Psychiatric Hospital provides comprehensive evaluation and short-term hospitalization for older adults experiencing severe depression, psychosis, anxiety, memory loss with behavioral problems, and other mental health and behavioral problems associated with aging. All patients receive a complete medical, psychiatric, and social/functional assessment. Treatment modalities include pharmacotherapy, psychosocial interventions, family therapy, physical rehabilitation, and electroconvulsive therapy.
Benedum Geriatric Center
The ambulatory care program of the Benedum Geriatric Center provides outpatient evaluation and treatment for older persons who have complex problems requiring multidisciplinary care. The Benedum Geriatric Center focuses primarily on frail seniors who have multiple medical, psychiatric, and/or psychosocial problems. Its main goal is preserving their health, independence, and well-being. Services include comprehensive medical, psychiatric, and social assessments; consultation for referring physicians and other community health care providers; environmental planning to maintain the patient’s residence at home for as long as possible; health care education, counseling, and psychotherapy for patients and families. The center averages over 750 patient visits per month and has more than 2,200 active patients. In addition to a three-month rotation, all fellows participate in a weekly clinic throughout the year to gain experience in longitudinal ambulatory care, including psychotherapy. These mental health services are complemented by on-site geriatric medicine, neurology, podiatry, nutrition counseling, and neuropsychological testing.
Geriatric In-Home Support Program
The Geriatric In-Home Support Program currently serves over 100 homebound older persons with psychiatric and physical illness who would otherwise not receive care or receive it only in a hospital or long-term care settings. The program’s target population are those chronically and persistently mentally ill older patients (60 years of age and older) who are unable to keep appointments in an outpatient setting and are at risk for institutionalization. These patients are usually the “oldest of the old” with medical problems and functional disability, cognitive or psychiatric disorders, and poor social support.
Geriatric Pain Clinic
The Geriatric Pain Clinic at the Pittsburgh VA Health System’s located on University Drive in Oakland is a multi-disciplinary clinic dedicated to the treatment of persistent pain. Physicians, nurses, psychologists, and rehabilitation specialists provide group and individual pain rehabilitation programs. Treatment is both interventional and conservative. Our multidisciplinary team works closely together to educate the patient and their family, and to re-conceptualize their attitude to the management of pain. Fellows participate in seven, half-day clinics during their ambulatory rotation.
Movement Disorders Clinic
Located within the Department of Neurology, fellows learn to assess and treat neurological disorders prevalent in older adults, with a particular focus on typical and atypical Parkinsonism and psychiatric co-morbidities. Equally important, our fellows serve as an invaluable resource to the neurology team as the mental health consultant within this clinic.
For two weeks during the ambulatory rotation, fellows gain intensive experience with palliative care services. Fellows accompany the Palliative Care team at the UPMC Presbyterian Hospital on daily rounds. During this rotation, fellows learn to more fully appreciate how an interdisciplinary approach can effectively address the physical, psychosocial, and spiritual needs of patients and families in end-of-life care, and obtain a better understanding of the communication skills needed and utilized when having difficult conversations with patients and their families regarding end-of-life care. They also gain valuable experience in the advanced care planning process through participation in goal-setting discussions with patients and families.
Long-Term Care – A Longitudinal Experience
The Geriatric Psychiatry program maintains contracts with a variety of long-term care facilities in Western Pennsylvania and has established several facilities as training sites. Fellows round weekly at their assigned nursing home under faculty supervision during each of the five rotation blocks. Pharmacotherapy and psychosocial/family interventions are the primary modes of treatment. Drug interactions, medical co-morbidity, psychosocial stressors, and medico-legal aspects of treating seniors in long-term care settings are emphasized.
During their Ambulatory Rotation, fellows will gain experience in the long-term care Special Care Unit for residents with severe behavioral problems of dementia or who have serious mental illness and require nursing home level care. This program focuses on behavioral management techniques, working closely with families and nursing home staff.
Physical Medicine and Rehabilitation
For one week during the ambulatory rotation, fellows gain experience in the evaluation and rehabilitation of patients who suffered stroke or traumatic brain injury. This is another opportunity to observe the administration of neuropsychological testing and implement the results of this testing in care planning. Fellows learn about the role of physical and occupational therapy in recovery from these conditions and how to implement rehabilitation principles in their own practice of caring for older adults with psychiatric illness.
The Geriatric Consultation/Liaison Service provides consultation and assessment services to older patients with psychiatric or behavioral problems who are undergoing treatment in UPMC’s acute care hospitals and medical and surgical services locations. This program provides consultation and education to all medical and surgical services, for both inpatient and ambulatory care cases. However, given the size of the UPMC health care system and the high volume of requests the Department of Psychiatry receives for consultations, geriatric psychiatry fellows only provide psychiatric consultations to older adults who are admitted to our medical and surgical hospitals. This reinforces the focus of training on late-life conditions commonly seen in hospitalized older adults such as delirium.
The Geriatric Research, Education and Clinical Center (GRECC) located at the VA Medical Center in Oakland provides fellows with the opportunity to work closely with specialists in geriatric medicine and neurology as part of multi-disciplinary teams. This rotation consists of working as part of a multidisciplinary team in an established Geriatric Evaluation Management (GEM) clinic, providing geriatric psychiatry care in a general neurology clinic, and participating in substance abuse treatment clinics for older veterans.
The VA Pittsburgh Healthcare System (VAPHS) provides a unique training experience for geriatric psychiatry fellows. Fellows provide geriatric psychiatry consultations to older patients on the in-patient service. Other clinical experiences include observing and providing care in the Teledementia Clinic, participating in a PTSD group for veterans of World War II and the Korean War, and the consultation-liaison service which helps many older patients with delirium and substance use disorders. The fellows also spend one day per week at the Community Living Center on the H.J. Heinz campus of the VAPHS.