Geriatric Psychiatry Lutz
Geriatric psychiatry for Lutz and the surrounding Hillsborough-Pasco line communities, adults 60 and older. In-person at our Wesley Chapel office or HIPAA-secure telehealth from home. Real medication review, late-life depression and anxiety expertise, and a clinician who takes the full medication list seriously.
Real geriatric care, without the six-month wait.
Tell us what is going on. A care coordinator will get you scheduled (in-person at Wesley Chapel or by video), walk through your coverage and self-pay options, and confirm a real next-available appointment.
Got it. We will be in touch.
A care coordinator will reach out within one business day. If you would rather not wait, call (813) 670-3005.
Lutz: a mature suburb that over-indexes on multigenerational households
Lutz sits on the Hillsborough and Pasco line and has aged in place differently from the newer family suburbs north and east of it. Cheval, Lake Park, Lake Magdalene, and Crystal Lake, along with the older homes off Sunset and Livingston, have produced a community weighted toward 55 and older relative to most of north Hillsborough.
A lot of Lutz households are also multigenerational: an adult child caring for an ageing parent under the same roof, or living nearby and handling everything. That household pattern shapes how these appointments actually run.
The adult child is part of the care team, not a bystander
More often here than anywhere else in our practice, an adult child is in the room, either at the Wesley Chapel office or on the video call, alongside the parent. Spouses are frequently involved as well.
We treat that as a feature of geriatric care rather than a complication to manage. The person who fills the pill organizer, drives to the appointments, and notices that dinner has been skipped three days running holds information the patient often cannot supply. With the patient's consent, that account makes the evaluation substantially more accurate.
There is a balance to hold. The patient is the patient, decisions are theirs while they have capacity, and some of the conversation needs to happen without the family in the room. We will ask for a few minutes alone at some point in a first visit, and that is not a sign anything is wrong.
Caregiver strain is a clinical finding, not a side conversation
When an adult child is managing a parent's medications, appointments, and finances while holding down a job, the strain is not incidental to the parent's care. It largely determines whether the plan gets carried out at all.
So we ask about it directly. How is your own sleep. Are you getting any time away from the house. Has anyone else in the family offered to take a share. Are you making decisions you never agreed to make. The answers change what we prescribe, because a complicated four-times-daily regimen handed to an exhausted caregiver is a regimen that will not be followed.
We are not the caregiver's treating clinician during that appointment, and we will say so plainly. What we can do is name what we are seeing, point toward Area Agency on Aging services and respite options across Hillsborough and Pasco, and build a plan the household can realistically run. A number of families need the plan simplified more than they need it intensified.
Agitation, sleep reversal, and the psychiatric side of dementia
Families rarely call about memory. They call about behavior. The late-afternoon agitation. The accusation that somebody has been taking money. The night and day reversal. The refusal to bathe.
Those symptoms are treatable, and the first line is usually not a medication. We look at pain the patient can no longer report clearly, at constipation, at a urinary tract infection, at hearing loss, and at the environment itself, because a substantial share of agitation in dementia is an unmet need being expressed by somebody who has lost the words for it.
Where medication is warranted, we are conservative about it. We discuss the risks candidly, including the risks specific to using antipsychotics in older adults with dementia, use the lowest workable dose, and revisit whether it is still needed rather than leaving it running indefinitely. Some patients and families see meaningful improvement and some do not, and we will not promise an outcome in advance.
We screen for cognitive change and treat the psychiatric symptoms that accompany dementia. For a comprehensive diagnostic workup we refer to neurology or a memory-disorder clinic and stay coordinated with that specialist afterward.
The medication review, and what usually comes off the list
Most new geriatric patients arrive on somewhere between six and fourteen medications prescribed by three or four different clinicians, none of whom has seen the whole list at once. Reviewing it properly is often the single highest-value hour in the first year of care, and it is the reason the intake runs sixty minutes rather than twenty.
Several patterns come up repeatedly. Anticholinergic load accumulates quietly, because the individual contributors are unremarkable on their own: an older antihistamine taken for sleep, a bladder medication, a tricyclic prescribed decades ago for something unrelated. Added together they produce exactly the confusion, dry mouth and constipation that get attributed to age or to early dementia. Benzodiazepines and the z-drugs started for sleep are the second pattern, and in older adults they carry a falls and cognitive cost that outweighs what they do for sleep. Neither is stopped abruptly; a taper is planned over weeks or months with the patient and the family told in advance what to expect.
Blood pressure medications get attention for a psychiatric reason. Orthostatic drops are a common cause of the near-falls and unsteadiness that families describe, and several psychiatric medications add to them, so the two lists have to be read together rather than separately. Anything changed here is communicated to the prescriber who owns it rather than altered around them.
Most Lutz families settle into a mix of formats. The sixty-minute intake often happens in the office so the patient and the family member can meet Margot face to face, and follow-ups afterward are split between video from home and the office as the week allows.
Fees are self-pay and settled at the appointment. We provide an itemized superbill afterward, carrying the diagnosis and procedure codes, which many patients send to Medicare themselves and receive partial reimbursement against. Ascend does not bill Medicare directly for psychiatric services.
Margot Krahn, PMHNP-BC
Margot Krahn, PMHNP-BC, is a board-certified, Florida-licensed psychiatric mental health nurse practitioner with twelve years of clinical experience. Her lifespan training covers child, adolescent, adult, and geriatric psychiatric care, which in practice means she has the explicit geriatric preparation that adult-only training does not include.
She sees Lutz-area patients face to face at the Wesley Chapel office and by secure video from home. Because so many households here are caring for a parent under one roof, a large share of her Lutz appointments involve two generations in the same room, and she structures the visit around that rather than working against it.
Read more about MargotFrequently Asked Questions
How is a first visit different from my parent's usual appointments?
It runs a full hour, and most of that hour is spent on things a fifteen-minute follow-up cannot reach: the whole medication list read at once, a timeline of when each change in mood, sleep or memory actually began, and what the person who lives with your parent has observed. You leave knowing what is being considered and what has been ruled out, rather than with a prescription and a return date.
Can I sit in on my father's appointment?
Yes, and for Lutz families in particular we encourage it. Where an adult child manages the medications, having that person in the room or on the call makes the evaluation considerably more accurate. We will usually also ask for a few minutes alone with your father at some point, which is routine rather than a signal that something is wrong.
I am worn out from looking after my mother. Is that something you can address?
We will ask about it, because it directly affects whether her plan is workable. We are not acting as your own clinician during her appointment, and we will be clear about that. What we can do is simplify the regimen so it is realistic, and point you toward Area Agency on Aging services and respite options in Hillsborough and Pasco.
My mother becomes agitated every afternoon. Is that treatable?
Often, yes, and frequently without adding a medication. We look first at pain she may no longer be able to describe, constipation, infection, hearing loss, and the environment itself, since a good deal of agitation in dementia is an unmet need expressed by someone who has lost the words. Where medication is genuinely warranted we use the lowest workable dose and review whether it is still needed.
Can my parent be seen if they use a walker or a wheelchair?
Yes. The Wesley Chapel suite is on the ground floor with level entry, and patients using walkers and wheelchairs are seen regularly. Say so when booking, because mobility is clinically relevant here rather than only logistically: falls risk shapes which medications are reasonable, and an unsteady gait is one of the findings that argues for an in-person visit over a video one.
Can we start in the office and move to video later?
That is the most common pattern here. Many families do the hour-long intake in person so everyone can meet, then alternate between video and office visits depending on the week, the transport situation, and how the patient is doing.
How does billing work?
Visits are self-pay and paid at the time. You then receive an itemized superbill with the diagnosis and procedure codes, which many patients submit to Medicare themselves for partial reimbursement. We do not bill Medicare directly for psychiatric services. Call (813) 670-3005 first and a coordinator will walk you through it.
Seen in the office, or from the kitchen table.
The Wesley Chapel office, or a video visit from home. An hour for the first appointment either way. Call us or use the form above and someone will be back to you within one business day.