Director: Prasad R. Padala, M.D.

Address: 985578 Nebraska Medical Center, Omaha, NE 68198-5578

Phone: (402) 552-6244   •   Fax: (402) 977-5684   •   E-mail: ppadala@umnc.edu

Level: PGY-5   •   Salary: $51,549 (2007-2008)   •   Positions: 2   •   Accreditation: ACGME

According to the U.S. Census Bureau, America’s population age 65 and older grew by 74 percent between 1970 and 1999 – from 20 million to almost 35 million. The elderly population will grow even more rapidly as 76 million baby boomers reach age 65 and older between 2010 and 2030. By 2030, older adults will account for 20 percent of the total population – up from 13 percent in 2000. Within this cohort, persons 85 years and older comprise the most rapidly growing segment of the U.S. population. The need for medical and psychiatric services for this population will likewise expand. Nearly 20 percent of those who are 55 years and older experience mental disorders. Most common, in order of prevalence, are: anxiety, severe cognitive impairment, and mood disorders. Studies report, however, that mental disorders in older adults are underreported. The rate of suicide is highest among older adults compared to any other age group — and the suicide rate for persons 85 years and older is the highest of all — twice the overall national rate. Conservative estimates are that 4% of the aged have an organic mental disorder and an additional 15% have a functional psychiatric disorder. Recent studies note that 50-80% of nursing home residents have a psychiatric disorder and that a prevalence as high as 40-50% for psychiatric disorders may exist in elderly patients hospitalized for medical and surgical problems. The converse is also true. In one study, 50% of elderly with psychiatric disorders were found to have an active, concomitant physical illness. These findings underscore the need for psychiatrists specifically trained to address the emotional and medical needs of this rapidly expanding population.

Creighton University Medical Center (CUMC) and the University of Nebraska Medical Center (UNMC) jointly administer the ACGME approved, 1 year fellowship. The goal of the program is to provide training that permits the resident to develop expertise in the prevention, diagnosis, evaluation, and treatment of mental disorders and disturbances in the elderly patient. This is accomplished by providing clinical experiences in inpatient, outpatient, consultative and long term care settings as well as rotations in geriatric medicine and neurology. The clinical experience will be supplemented with a didactic program that includes lecture, seminar and case conference modalities. The importance of collaborative work with other mental health professionals, medical specialists, and care systems will be emphasized throughout the clinical and didactic experience. Finally, research experience to promote critical reading of the literature, an appreciation of the rigors of advancing psychiatric knowledge and in applying findings from the literature to clinical care will be provided to all fellows.

1. Survey of Geriatric Psychiatry — A 35 week offering covering biopsychosocial aspects of aging, the major psychiatric syndromes affecting the elderly as well as administrative, ethical, legal and long term care issues. Treatment of the major psychiatric and behavioral syndromes common to the elderly are reviewed.
2. Geriatric Medicine Seminar — This 6 hour course is taken during the geriatric medicine rotation to address functional assessment, incontinence, medications in the aged, fall assessment and cognitive impairment.
3. Clinical Research Symposium — a two week course offered by the Clinical Research Center at UNMC focusing on the basics of research methodology, biostatistics, epidemiology, and grant writing skills.
4. Geriatric Journal Club — Geriatric medicine and geriatric psychiatry staff and trainees meet on a monthly basis to review articles from the geriatric medical and geriatric psychiatry literature. Literature is chosen to illustrate treatment, pathophysiology, research and statistical methodology in order to facilitate critical reading of the literature.
5. Geriatric Case Conference — A collaborative effort with Geriatric Medicine in which cases are used to demonstrate teaching issues and promote discussion among faculty and residents.
   
   

1. Geriatric Psychiatry Inpatient at the Alegent Heritage Center for a two month period. This clinical rotation is aimed at providing hands on experience in the treatment of common mental illnesses in geriatric population. Extensive experience in electro- convulsive therapy is available for residents. Another niche to this program is the integrated partial hospitalization program which offers the fellows a unique opportunity to see the patients engaged in recovery after discharge from an acute inpatient unit. Drs. Hasnain Sadiq and Arun Sharma run this service.
2. Inpatient and outpatient consultative services at the Nebraska Medical Center. Inpatient service at the Nebraska Medical Center is run on a monthly rotation by Drs. Magnuson, Roccaforte and Wengel. Outpatient consultative experiences will include the multidisciplinary Geriatric Assessment Program.
3. Outpatient clinic for 12 months. The outpatient experience is currently being offered at the Richard Young Center, which houses the psychiatry department at the University of Nebraska Medical Center.
4. A one month experience in geriatric neurology at the Nebraska Medical Center with the Neurology Department team. An excellent team of neurologists is available at the NMC including Dr. Daniel Murman, a geriatric neurologist, Dr. Pierre Fayad, a specialist in stroke and Dr. Sanjay Singh, an epileptologist.
5. A one month outpatient geriatric medicine rotation under the direct supervision of the geriatric medicine team. Experiences include the specialty outpatient clinic, home visits, and hospice care.
6. Nursing Home rotation at the Douglas County Long Term Care Facility.
   
   

1. Supervision of the general psychiatry residents and medical students assigned to the geriatric inpatient unit.
2. Liaison service provided to physicians in other specialties, their trainees and to other members of the health care teams when providing consultative services.
3. The opportunity will exist to give lectures in the general residents' and medical students' didactics.
4. Fellows may participate in seminars related to teaching in the UNMC and CUMC Faculty Development programs.
   
   

The fellow may devote up to 40% of the second semester to research as an elective part of their training. The research consortium at UNMC headed by Dr. William J. Burke, MD is a center of excellence in clinical trials in aging population. Our previous and ongoing research included clinical trials of all cholinesterase inhibitors, depression treatment trials, and Vagal Nerve Stimulation. Dr. Burke has a RO1 grant to study the prevention of depression in patients with Head and Neck Cancer. Dr. Dennis P. McNeilly, PsyD, has an ongoing treatment study of pathological gambling. Dr. Prasad R. Padala, MD has an ongoing treatment trial of methylphenidate for apathy in Alzheimer’s Dementia funded by the Veterans Health Administration.

1. There will be continual feedback on a day-to-day basis to the resident from the staff psychiatrists of the various services.
2. Formal written evaluations assessing the fellow's progress in clinical performance on all rotations will be given. The fellow will meet with the program director on a quarterly basis to review these reports and a written report of these meetings will be placed in the trainee's file.
   
   

The fellow will give written evaluations for each rotation and the supervision provided by the attendings on those respective services. This material will be reviewed by the Training Committee for ongoing quality assessment.

Please refer to the Our Faculty & Staff section for more information about the Geriatric Psychiatry Fellowship faculty.

Prospective geriatric fellows will need to submit a formal application during the year preceding their projected entry into the program. Completion of a general psychiatry residency is mandatory, as is a current license to practice medicine or eligibility for receiving one in the state of Nebraska. For more information contact:
Contact: Adrienne VanWinkle, or Prasad R. Padala, M.D., Program Director
Phone: (402) 552-6244
Email: avanwink@unmc.edu   •   ppadala@unmc.edu

To top