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Am J Geriatr Psychiatry. 2014 Nov;22(11):1251-61. doi: 10.1016/j.jagp.2013.04.013. Epub 2013 Aug 14.

Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness.

Author information

1
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH. Electronic address: sbartels@dartmouth.edu.
2
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH.
3
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Psychiatric Research Center, Lebanon, NH; Center for Psychiatric Rehabilitation, Boston University, Boston, MA.
4
Department of Psychiatry, Harvard University, Cambridge, MA; Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA.
5
Dartmouth Psychiatric Research Center, Lebanon, NH.
6
Schizophrenia Program, Massachusetts General Hospital, Boston, MA.
7
Vinfen, Cambridge, MA.
8
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH.
9
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH.
10
Massachusetts Mental Health Center, Boston, MA.

Abstract

OBJECTIVE:

This report describes 1-, 2-, and 3-year outcomes of a combined psychosocial skills training and preventive healthcare intervention (Helping Older People Experience Success [HOPES]) for older persons with serious mental illness.

METHODS:

A randomized controlled trial compared HOPES with treatment as usual (TAU) for 183 older adults (age ≥ 50 years [mean age: 60.2]) with serious mental illness (28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression) from two community mental health centers in Boston, Massachusetts, and one in Nashua, New Hampshire. HOPES comprised 12 months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive healthcare visits, followed by a 1-year maintenance phase of monthly sessions. Blinded evaluations of functioning, symptoms, and service use were conducted at baseline and at a 1-year (end of the intensive phase), 2-year (end of the maintenance phase), and 3-year (12 months after the intervention) follow-up.

RESULTS:

HOPES compared with TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive healthcare (more frequent eye exams, visual acuity, hearing tests, mammograms, and Pap smears), and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at the 3-year follow-up.

CONCLUSION:

Skills training and nurse facilitated preventive healthcare for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive healthcare screening, and advance care planning.

KEYWORDS:

Older adults; healthcare management; integrated care; preventive healthcare; psychosocial skills training; serious mental illness

PMID:
23954039
PMCID:
PMC3836872
DOI:
10.1016/j.jagp.2013.04.013
[Indexed for MEDLINE]
Free PMC Article

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