Telepsychiatry: The Evaluation and Treatment of Seniors in Rural Retirement Communities


  • Susanne Inez Steinberg Medical Director & Psychiatrist Penn Med Princeton House Behavioral Health, Moorestown, NJ 08057, United States
  • Robert Gallop Applied Statistics Program, Department of Mathematics, West Chester University, West Chester, PA 19383, United States



Few studies examine the benefits from geriatric telepsychiatry in rural retirement communities. Objectives: 1. To demonstrate that using telepsychiatry a) standard approaches to psychiatric evaluation would yield diagnoses in Diagnostic and Statistical Manual of Mental Disorders (DSM-V); b. psychotherapies and pharmacotherapy could be effectively administered.  2. To examine the relationships among cognition, mood, agitation and functions at baseline and the response to treatment over time. Design: Prospective longitudinal study. Measures: Geriatric Depression scale (GDS), Mini Mental State Exam (MMSE), Barthel Index (BI), Pittsburgh Agitation Scale (PAS).  Setting: Video Teleconferencing.  Interventions: Psychotherapy, psychopharmacology. Participants: 428 Seniors over 55, met criteria for at least one DSM-V diagnosis. Results: Treatments were administered for a full range of psychiatric diagnoses and age-related medical conditions.  The most frequently prescribed pharmacological agents were: antidepressants (78%) antipsychotics (64%), memory enhancers (38%).   Participants (66%) received psychotherapy: individual (31%), couple (7%), family (13%). Variation in the MMSE scores were observed: 55% remained stable, 11% declined, 18% improved. GDS Scores improved from baseline to 26 weeks (p=0.02, d=0.99: 95% CI 0.39-1.56). PAS scores declined from baseline to 52 weeks  (McNemar’s S= 11.27, p=0.0008, d=1.17: 95% CI 0.63-1.68).   Function (BI) at week 26 was not statistically significantly different from baseline (t(26)=1.66, p=0.11, d=0.65: 95%CI -0.16-1.42). Participants maintained independence (64.5%) at 52 weeks  (McNemar’s S = 6.23, p=0.013, d=0.79: 95%CI 0.19-1.36) Conclusion: This study demonstrates the feasibility and benefit of providing a full complement of services via telepsychiatry to seniors and provides a rationale for more comprehensive reimbursement plans . 


Psychotherapy;Psychopharmacology;Telepsychiatry;Seniors;Retirement communities;Nursing Homes


[1] Shore JH. Telepsychiatry: videoconferencing in the delivery of psychiatric care. Am J Psychiatry, 2013,170(3): 256-262.

[2] Shore JH, Mishkind MC, Bernard J, et al. A lexicon of assessment and outcome measures for telemental health. Telemed J E Health, 2014, 20(3): 282-292.

[3] Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health,2013, 19(6): 444-454.

[4] Morland LA, Mackintosh MA, Greene CJ, et al.Cognitive processing therapy for posttraumatic stress disorder delivered to rural veterans via telemental health: a randomized noninferiority clinical trial. JClin Psychiatry, 2014, 75(5): 470-476.

[5] Gentry MT, Lapid MI, Rummans TA. Geriatric Telepsychiatry: Systematic Review and Policy Considerations. The American Journal of Geriatric Psychiatry,2019, 27(2): 109-127.

[6] Parikh M, Grosch MC, Graham LL, et al. Consumer Acceptability of Brief Videoconference-based Neuropsychological Assessment in Older Individuals with and without Cognitive Impairment. The Clinical neuropsychologist, 2013, 27(5): 808-817.

[7] Vahia IV, Ng B, Camacho A, et al. Telepsychiatry for Neurocognitive Testing in Older Rural Latino Adults.The American Journal of Geriatric Psychiatry, 2015,23: 666-670.

[8] Timpano F, Pirrotta F, Bonanno L, et al. Videoconference-Based Mini Mental State Examination: A Validation Study. Telemedicine and e-Health. 2013,19(12): 931-937.

[9] Cullum CM, Hynan LS, Grosch M, et al. Teleneuropsychology: Evidence for Video Teleconference-Based Neuropsychological Assessment. Journal of the International Neuropsychological Society,2014, 20(10): 1028-1033.

[10] Martin-Khan, M. Flicker, L. Woooton, R. et al. The Diagnostic accuracy of telegeriatrics for the diagnosis of dementia via videoconferencing. Journal of American Medical Director Association, 2012,13(487): e419-424.

[11] Poon P, Hui E, Dai D, Kwok T, Woo J. Cognitive intervention for community-dwelling older persons with memory problems: telemedicine versus face-toface treatment. 2005, 20(3): 285-286.

[12] Rabinowitz T, Murphy KM, Amour JL, Ricci MA,Caputo MP, Newhouse PA. Benefits of a telepsychiatry consultation service for rural nursing home residents. Telemed J E Health, 2010, 16(1): 34-40.

[13] Egede LE, Gebregziabher M, Walker RJ, Payne EH,Acierno R, Frueh BC. Trajectory of cost overtime after psychotherapy for depression in older Veterans via telemedicine. Journal of Affective Disorders,2017, 207: 157-162.

[14] Weiner MF, Rossetti HC, Harrah K. Videoconference diagnosis and management of Choctaw Indian dementia patients. Alzheimer's & Dementia, 2011, 7(6):562-566.

[15] Egede LE, Acierno, R. Knapp, RG. Lejuez, C. Psychotherapy for depression in older veterans via telemedicine: a randomized, open label, non inferiority trial. Lancet Psychiatry, 2015, 2(8): 693-701.

[16] Choi NG, Marti CN, Bruce ML, Hegel MT, Wilson NL, Kunik ME. Six-month postintervention depression and disability outcomes of in-home telehealth problem-solving therapy for depressed, low-income homebound older adults. 2014, 31(8): 653-661.

[17] Lichstein KL, Scogin F, Thomas SJ, DiNapoli EA,Dillon HR, McFadden A. Telehealth Cognitive Behavior Therapy for Co-Occurring Insomnia and Depression Symptoms in Older Adults. Journal of Clinical Psychology, 2013, 69(10): 1056-1065.

[18] Hilty DM, Rabinowitz T, McCarron RM, et al. An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care. Psychosomatics, 2018, 59(3): 227-250.

[19] Rosen J, Burgio L. Killar M. et al. The Pittsburgh Agitation Scale: A User Friendly instrument for rating agitation in dementia patients for the clinician.Am J Geriatric Psychiatry, 1994, 2: 52-59.

[20] Mahoney F, Barthel D. Functional Evaluation: The Barthel Index. Maryland State Medical Journal,1965: 62-65.

[21] Chinn S. A simple method for converting an odds ratio to an effect size for use in meta-analysis, Statistics in Medicine. Statistics in Medicine, 2000, 19: 3127-3133.

[22] Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, New Jersey: Lawrence Erlbaum Associates, 1988.

[23] SAS Institute Inc. SAS® 9.4 Language Reference:Concepts (5th ed. Cary, NC: SAAS Institute Inc.,2015.

[24] Mann DAM, Snowden, J. Frontotemporal lobar degeneration: Pathogenesis, pathology and pathways to phenotype. Brain Pathology, 2017, 23: 723-736.

[25] Graff-Radford, J. Aakre, J. Savica, R. Boeve, B. etal. Duration and Pathologic Correlates of Lewy Body Disease. JAMA neurology, 2017, 74(3): 310-315.

[26] Sachdev PL, JW. Crawford, JD. Mellon, L. STROKOG (stroke and cognition consortium): An international consortium to examine the epidemiology,diagnosis and treatment of neurocognitive disorders in relation to cerebrovascular disease. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 2017, 7: 11-23.

[27] Sim V. Prion Disease: Chemotherapeutic Strategies.Infectious Disorders - Drug Targets, 2012, 12(2):144-160.

[28] Rub, U. Seidel, K. Heinsen, H. Vonsattel, JP. den Dunnen,WF. Korf, HW. Huntington’s disease (HD):the neuropathology of a multisystem neurodegenerative disorder of the human brain. Brain Pathology,2016, 26: 726-740.

[29] Cavallo MS, A. Perucchini, ML. Benefits of Cognitive Treatments Administered to Patients Affected by Mild Cognitive Impairment / Mild Neurocognitive Disorder. Drug Development Research, 2016, 77:444-452.

[30] Cummings JL, Lyketsos CG, Peskind ER, et al. Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia: A Randomized Clinical Trial. JAMA : the journal of the American Medical Association, 2015, 314(12): 1242-1254.

[31] Khan A, Faucett J, Morrison S, Brown WA. Comparative mortality risk in adult patients with schizophrenia, depression, bipolar disorder, anxiety disorders,and attention - deficit / hyperactivity disorder participating in psychopharmacology clinical trials. JAMA Psychiatry, 2013, 70(10): 1091-1099.

[32] Devanand DP. Psychosis, agitation, and antipsychotic treatment in dementia. Am J Psychiatry, 2013,170(9): 957-960.

[33] Simoni Wastila L, Wei YJ, Luong M, et al. Quality of psychopharmacological medication use in nursing home residents. Res Social Adm Pharm, 2014, 10(3):494-507.

[34] Kryscio RJ, Abner EL, Cooper GE, et al. Self-reported memory complaints: implications from a longitudinal cohort with autopsies. Neurology, 2014, 83(15):1359-1365.

[35] Alexopoulos GS, Reynolds CF, 3rd, Bruce ML, et al.Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry, 2009, 166(8):882-890.

[36] Gallo JJ, Morales KH, Bogner HR, et al. Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ, 2013, 346: f2570.

[37] Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med., 2010, 363(27): 2611-2620.

[38] Terum TA, JR. Rongve, A. Svendsboe, EJ. The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review. International journal of geriatric psychiatry,2017. DOI:

[39] Steinberg S, Sammel M, Harel B, et al. Exercise,Sedentary Pastimes and Cognitive Performance in Healthy Adults. American Journal of Alzheimer’s Disease & Other Dementias, 2015, 30(3): 290-298.

[40] Tso JV, Farinpour R, Chui HC, Liu CY. A Multidisciplinary Model of Dementia Care in an Underserved Retirement Community, Made Possible by Telemedicine. Frontiers in Neurology, 2016.

[41] Brenes GA, Danhauer SC, Lyles MF, Hogan PE,Miller ME. Telephone-delivered cognitive behavioral therapy and telephone-delivered nondirective supportive therapy for rural older adults with generalized anxiety disorder: A randomized clinical trial. JAMA Psychiatry, 2015.


How to Cite

Steinberg, S. I., & Gallop, R. (2020). Telepsychiatry: The Evaluation and Treatment of Seniors in Rural Retirement Communities. Journal of Geriatric Medicine, 1(2), 23–31.


Article Type