 |
|
Effectiveness of a Nurse-Based Outreach Program for Identifying and Treating Psychiatric Illness in the Elderly
Peter V. Rabins, MD, MPH;
Betty S. Black, PhD;
Robert Roca, MD, MPH;
Pearl German, ScD;
Marsden McGuire, MD;
Beatrice Robbins, RN, MSN;
Rebecca Rye, RN, BSN;
Larry Brant, PhD
JAMA. 2000;283:2802-2809.
Context Elderly persons with psychiatric disorders are less likely than younger adults to be diagnosed as having a mental disorder and receive needed mental health treatment. Lack of access to care is 1 possible cause of this disparity.
Objective To determine whether a nurse-based mobile outreach program to seriously mentally ill elderly persons is more effective than usual care in diminishing levels of depression, psychiatric symptoms, and undesirable moves (eg, nursing home placement, eviction, board and care placement).
Design Prospective randomized trial conducted between March 1993 and April 1996 to assess the effectiveness of the Psychogeriatric Assessment and Treatment in City Housing (PATCH) program.
Setting Six urban public housing sites for elderly persons in Baltimore, Md.
Participants A total of 945 (83%) of 1195 residents in the 6 sites underwent screening for psychiatric illness. Among those screened, 342 screened positive and 603 screened negative. All screen-positive subjects aged 60 years and older (n=310) and a 10% random sample of screen-negative subjects aged 60 years and older (n=61) were selected for a structured psychiatric interview. Eleven subjects moved or died; 245 (82%) of those who screened positive and 53 (88%) of those who screened negative were evaluated to determine who had a psychiatric disorder. Data were weighted to estimate the prevalence of psychiatric disorders at the 6 sites.
Intervention Among the 6 sites, residents in 3 buildings were randomized to receive the PATCH model intervention, which included educating building staff to be case finders, performing assessment in residents' apartments, and providing care when indicated; and residents in the remaining 3 buildings were randomized to receive usual care (comparison group).
Main Outcome Measures Number of undesirable moves and scores on the Montgomery-Asberg Depression Rating Scale (MADRS), a measure of depressive symptoms, and the Brief Psychiatric Rating Scale (BPRS), a measure of psychiatric symptoms and behavioral disorder, in intervention vs comparison sites.
Results Based on weighted data, at 26 months of follow-up, psychiatric cases at the intervention sites had significantly lower (F1=31.18; P<.001) MADRS scores (9.1 vs 15.2) and significantly lower (F1=17.35; P<.001) BPRS scores (27.4 vs 33.9) than those at the nontreatment comparison sites. There was no significant difference between the groups in undesirable moves (relative risk, 0.97; 95% confidence interval, 0.44-2.17).
Conclusions These results indicate that the PATCH intervention was more effective than usual care in reducing psychiatric symptoms in persons with psychiatric disorders and those with elevated levels of psychiatric symptoms.
Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Drs Rabins and Black and Mss Robbins and Rye) and Medicine (Drs Rabins and German), School of Medicine, and Departments of Health Policy and Management (Drs Rabins and German) and Mental Hygiene (Dr Rabins), School of Hygiene and Public Health, Johns Hopkins Medical Institutions, Sheppard and Enoch Pratt Hospital (Drs Roca and McGuire), and Gerontology Research Center, National Institute on Aging (Dr Brant), Baltimore, Md.
RELATED ARTICLES
The Public Health Model for Mental Health Care for the Elderly
Ira R. Katz and James C. Coyne
JAMA. 2000;283(21):2844-2845.
EXTRACT
| FULL TEXT
June 7, 2000
JAMA. 2000;283(21):2861-2862.
EXTRACT
| FULL TEXT
Psychiatric Illness in Older Adults
JAMA. 2000;283(21):2886.
PDF
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Primary Care After Psychiatric Crisis: A Qualitative Analysis
Griswold et al.
Ann Fam Med 2008;6:38-43.
ABSTRACT
| FULL TEXT
Geropsychiatric Nursing Practice in the United States: Present Trends and Future Directions
Kaas and Beattie
J Am Psychiatr Nurses Assoc 2006;12:142-155.
ABSTRACT
Geropsychiatric Nursing: The State of the Science
Kolanowski and Piven
J Am Psychiatr Nurses Assoc 2006;12:75-99.
ABSTRACT
Just for Us: An Academic Medical Center-Community Partnership to Maintain the Health of a Frail Low-Income Senior Population
Yaggy et al.
Gerontologist 2006;46:271-276.
ABSTRACT
| FULL TEXT
Connections to Primary Medical Care after Psychiatric Crisis
Griswold et al.
J Am Board Fam Med 2005;18:166-172.
ABSTRACT
| FULL TEXT
Care staff training in detection of depression in residential homes for the elderly: Randomised trial
Eisses et al.
Br. J. Psychiatry 2005;186:404-409.
ABSTRACT
| FULL TEXT
A Systematic Review of the Effectiveness of Community-Based Mental Health Outreach Services for Older Adults
Van Citters and Bartels
Psychiatr. Serv. 2004;55:1237-1249.
ABSTRACT
| FULL TEXT
Assessment of Depression and Cognitive Impairment Among Elders in Rural Housing Facilities
Fisher and Shumaker
J Am Psychiatr Nurses Assoc 2004;10:67-72.
ABSTRACT
Improving the United States' System of Care for Older Adults With Mental Illness: Findings and Recommendations for The President's New Freedom Commission on Mental Health
Bartels
AJGP 2003;11:486-497.
ABSTRACT
| FULL TEXT
Suicidality in Older African Americans: Findings From the EPOCH Study
Cook et al.
AJGP 2002;10:437-446.
ABSTRACT
| FULL TEXT
Home Visits in Geropsychiatry Fellowship Training
Roane et al.
Gerontologist 2002;42:109-113.
ABSTRACT
| FULL TEXT
Other articles noted
Evid. Based Nurs. 2000;3:106-112.
FULL TEXT
General Medicine: Nurse Outreach Program Improves Psychiatric Outcomes for Elderly
JWatch Psychiatry 2000;2000:11-11.
FULL TEXT
Nurse Outreach Program Improves Psychiatric Outcomes for Elderly
JWatch General 2000;2000:4-4.
FULL TEXT
|
