Hippocampal Volume and Cardiovascular Risk Using the QRISK2 Prediction Tool in Cognitively Normal Elderly

Introduction: The Institute of Medicine workforce report titled “In Whose Hands?” highlights there will never be enough specialists to care for a growing older population. Task shifting, or task sharing, is an increasingly popular topic in global mental health that describes the rational reallocation of resources to effectively treat mental health conditions in low resource areas. Task shifting was originally studied in global HIV/AIDS treatment but is increasingly discussed in global mental health including mental health services for older adults in the U.S. Methods: We conducted a review of the current literature on task shifting / sharing activities in rural areas of the U.S. where many older adults reside. The review included a search of PubMed for terms related to task shifting and rural mental health. A review of the grey literature and outreach to experts in the field enhance this review as much of the literature on task shifting in mental health is not yet published in peer reviewed journals. In reviewing articles we excluded those with a telehealth focus if they did not include sharing care tasks among a team of providers. Results: Findings focused on models of care in rural areas that involve sharing of tasks telemental health (e.g. with a primary care team), work involving community health workers, and Collaborative Care for common mental disorders. Technology may or may not be involved in the delivery of care in these rural areas. These efforts in task sharing in rural mental health can improve access and quality to care while altering the patient experience of care. Risks and unintended consequences in task shifting care however were seldom discussed. The importance of partnering with communities in these task shifting strategies however was highlighted. Conclusions: Task sharing holds potential in rural and low resource areas of the U.S., in particular for the care of a growing older adult population. We prefer the term task sharing as in many rural areas there is a lack of providers to shift tasks from and providers must rely on strategies to share tasks. Substantial gaps in the literature on task shifting / sharing remain. We recommend some key research questions and future directions for research in this important area.