The effectiveness of assertive community treatment for elderly patients with severe mental illness: a randomized controlled trial

Abstract

BackgroundDue to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults.MethodsIn a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients’ psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat.ResultsOf the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables.ConclusionsThese findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully.Trial registrationNTR1620

Evaluation of a Rural-Based Community Aged Intensive Recovery Program for Older Adults With Severe Mental Illness

“…Results from the preliminary evaluation have important clinical and service delivery implications. The current study found that most clients treated with the CAIR program remained treated in the community, supporting previous research highlighting that the intensive recovery program promotes person-centered care, encourages collaborative treatment, and reduces the negative consequences associated with admitting older adult clients to a psychiatric hospital (Burns et al, 2007;Pratt et al, 2008;Stobbe et al, 2014). Maintaining clients' connections to their family, carers, and community empowers them to remain in a familiar/ local environment and has the potential to reduce stigma of mental illness (Miller & Brewerton, 2009).…”

“…settings because inpatient psychiatric beds are often less accessible (Miller & Brewerton, 2009). Although increasing research has been devoted toward implementing and testing this intensive model of psychiatric care (Pratt, Van Citters, Mueser, & Bartel, 2008;Stobbe et al, 2014;Wilberforce et al, 2011), few studies have investigated the effectiveness of a Community Aged Intensive Recovery (CAIR) program for acutely unwell older adults residing in rural or remote settings.…”

“…Mental health services are beginning to explore whether intensive community recovery programs benefit older adults with severe mental illness. Stobbe et al (2014) recently conducted a randomized controlled trial in the Netherlands that suggested an intensive treatment program assisted older adults in better engaging with the service compared to clients who received treatment as usual. Additional international studies in the United States (Marshall & Lockwood, 2000), the United Kingdom (Wilberforce et al, 2011), and Australia (Miller & Brewerton, 2009) have also found promising results from intensive community programs, including reductions in hospital admissions, better quality of life, and improvements in psychiatric symptoms.…”

Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies

“…The three studies which met the inclusion criteria were published in 1996, 2010 and 2014 respectively. One study was carried out in the Netherlands [23], one in Austria [22] and one in Great Britain [21]. All of them were randomized controlled trials.…”

Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

“…25,26 However, the evidence for innovative mental health care strategies for elderly people is scarce. 27 Most studies using ACT, [28][29][30] HT, [31][32][33][34][35] or CRT [36][37][38] did not specifically report whether the innovative care models reduced AHLS in geriatric populations with mental health care needs. A British study showed that CRT and HT significantly reduced admissions of elderly mentally ill patients, but there was no significant difference in AHLS as compared before and after the introduction of these services.…”