Incorporating a frailty dimension into LOCUS for seniors in a medical-psychiatry population

Read more about the project here.

Seniors with mental health disorders commonly have significant medical comorbidities that increase impairment, disability and health service utilization. Although high healthcare utilization rates by older adults have been well documented, no validated tools exist to accurately identify which patients within this population will require more healthcare resources than others.

Both Trillium Health Partners (THP) and the Centre for Addiction and Mental Health (CAMH) have successfully used a utilization management tool, the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS) in their adult clinical mental health populations. Both hospitals now plan to implement the LOCUS in the seniors’ populations as a quality improvement project by adding a frailty dimension to the LOCUS tool, as the LOCUS has not been validated for use with seniors.

This study is the first of its kind to evaluate the variance between the LOCUS predicted level of required healthcare resources, and the actual level of care provided to seniors with mental health disorders and medical comorbidity. Ordinal logistical and categorical regressions were used to determine the extent to which independent frailty variables were able to predict the actual level of care.

Richard Shulman, MDCM, FRCPC is an Assistant Professor of the University of Toronto, Faculty of Medicine, Department of Psychiatry, in the Division of Geriatric Psychiatry. He is the Service Medical Director for Seniors Mental Health Services at Trillium Health Partners (Mississauga Hospital, Queensway Healthcare Centre and Credit Valley Hospital). Additionally, he is the consultant Geriatric Psychiatrist to the Special Behavioural Support Unit at Sheridan Villa LTC. Dr. Shulman was the Chief Editor of the Mental Health First Aid for Seniors Course (in conjunction with the Mental Health Commission of Canada) being launched in 2017 and is the inventor of the Sour Seven Delirium Detection Questionnaire for Caregivers. He is also accredited as an expert in contemporaneous and retrospective capacity evaluations by the Superior Court of Justice of Ontario.