<h4>EXCERPT</h4> <p>Depression and dementia are the two most frequent psychiatric syndromes in the older adult population, yet depression in older adults with and without dementia often goes unrecognized and untreated (Charney et al., 2003; Kales, Chen, Blow, Welsh, &amp; Mellow, 2005). Estimates of the prevalence of depression in older adults with dementia vary widely (Alexopoulos &amp; Abrams, 1991; Wragg &amp; Jeste, 1989), which is attributed to differences in sampling, diagnostic criteria used to identify depression, and the way it is assessed (Alexopoulos &amp; Abrams, 1991; McCabe et al., 2006). In a recent study conducted in a nursing home, 25% of residents screened positive for major depression (Gruber-Baldini et al., 2005). This is close to the prevalence rate of major depression reported for individuals with Alzheimer&rsquo;s disease (15% to 20%, Alexopoulos &amp; Abrams, 1991; 22%, Lyketsos et al., 1997; 10% to 20%, Wragg &amp; Jeste, 1989).</p>

Depression and dementia are the two most common psychiatric syndromes in the older adult population. Depression in older adults with and without dementia often goes unrecognized and untreated. The current guideline recommends a three-step procedure that can be used across health care settings to screen for the presence of depressive symptoms. Implementation of the evidence-based guideline requires administration of the Mini-Mental State Examination and either the Geriatric Depression Scale Short Form or Cornell Scale for Depression in Dementia, depending on level of cognitive functioning. The algorithm provided is designed to be used by nurses, physicians, and social workers for the purpose of depression screening in older adults with dementia. Detection of depression in individuals with dementia is hindered by a lack of a validated, brief screening tool. More research is needed on the use of such screenings among older adults with cognitive impairment.

Background and Objectives: Older adults are the fastest growing subset of the population and residency training in the basic concepts of care to the older adult is limited. We created a 1-day interactive training program, Advanced Geriatric Evaluation Skills (AGES), to upskill first-year primary care residents in the care of older adults. Methods: An interprofessional faculty team developed and taught the IRB-approved course to a convenience sample of family medicine and internal medicine interns in 2017, 2018, and 2019. Topics addressed common geriatric presentations seen in the outpatient setting. The faculty provided useful tips and hints for successful workup, diagnosis, and treatment. Results: Over the 3 years, 56 of the 135 (41%) first-year primary care residents participated. Residents reported that the course was well organized, relevant, and well taught, and they appreciated the dedicated time to focus on caring for older adults. During 2019, residents completed a pre- and posttest with 25 multiple-choice questions. The average score on the pretest was 76% and the average on the posttest was 88%. Ninety percent of the residents improved their score from the pre- to the posttest. Conclusions: The development of an AGES program provided a structured geriatric didactic curriculum for primary care residents. The course was well received by the residents, was reported to be relevant and timely, and resulted in increased knowledge in the care of older adults in the outpatient setting.

Objective: Documenting advance care planning (ACP) in primary care requires multiple triggers. New Medicare codes make it easier for providers to bill for these encounters. This study examines the use of patient and provider reminders to trigger advance care planning discussions in a primary care practice. Secondary outcome was billing of new ACP billing codes. Methods: Patients 75 years and older scheduled for a primary care appointment were screened for recent ACP documentation in their chart. If none was found, an electronic or mail message was sent to the patient, and an electronic message to their provider, about the need to have discussion at the upcoming visit. Chart review was performed 3 months after the visit to determine if new ACP discussion was documented in the chart. Results: In the 3 months after the reminder had been sent to patients and providers, new ACP documentation or billing was found in 28.8% of the patients. Most new documentation was health care decision maker (75.6% of new documentation) with new DNR orders placed for 32.3% of these patients. The new Medicare billing code was filled 10 times (7.8%). Conclusion: Reminders sent to both patients and providers can increase documentation of ACP during primary care visits, but rarely triggers a full ACP conversation.

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