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

Background: Due 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.Methods: In 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.Results: Of 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.Conclusions: These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully.Trial registration: NTR1620

Bewijs voor effectiviteit van Comprehensive Geriatric Assessment in de thuissituatie nog mager: een literatuurreview

Achtergrond De meeste ouderen vinden het belangrijk zo lang mogelijk zelfstandig te blijven functioneren. Gerichte opsporing en behandeling van factoren die de functionele zelfstandigheid bedreigen, middels een comprehensive geriatric assessment (CGA), kan het zelfstandig functioneren mogelijk bevorderen. Dit artikel doet verslag van een literatuurstudie naar het effect van comprehensive geriatric assessment in de thuissituatie. Methode In Pubmed (1977–2012) is gezocht naar RCT’s die de effectiviteit van multidisciplinaire, multidimensionele CGA bij ouderen in de thuissituatie onderzocht hebben. Er werden data geëxtraheerd over effectiviteit, kosten en factoren die het effect van het CGA positief of negatief hebben beïnvloed. Resultaten Negen RCT’s werden geïncludeerd. Op één studie na was de kwaliteit matig tot goed. In drie van de zes studies naar functionele status en in twee van de vier studies naar kwaliteit van leven werd een positief effect gevonden. Geen effect werd gevonden op het aantal ziekenhuisopnames en verpleeghuisopnames of op mortaliteit. De meeste studies lieten een stijging zien van de totale gezondheidszorgkosten. Conclusie CGA thuis heeft een beperkt gunstig effect op functionele status en kwaliteit van leven. Er zijn aanwijzingen dat CGA thuis het meeste effect heeft bij relatief goed functionerende ouderen

Verborgen zorgbehoeften bij ouderen

Over het algemeen blijven ouderen, ook hoogbejaarden, langer vitaal en onafhankelijk. Ouder worden kan echter ook geleidelijk of plotseling gepaard gaan met kwetsbaarheid. Een multidisciplinair assessment kan dan nodig zijn voor een samenhangend zorgadvies. Het Vivium ABC (Advies en Behandel Centrum) is een regionaal werkend multidisciplinair ambulant ouderenteam dat zich sinds 2003 bezighoudt met de complexe zorgproblematiek van kwetsbare ouderen in de regio Gooi Noord en noordelijke Vechtstreek. In 2009 werd een dossieronderzoek verricht om inzicht te verkrijgen in de verwijsvragen en karakteristieken van alle cliënten die in dat jaar werden aangemeld. 84 consulten werden geanalyseerd. Van de cliënten woonde 32% thuis en 61% in een zorgcentrum. De cliënten van het Vivium ABC zijn overwegend zeer oude mensen: bijna 60% is ouder dan 85 jaar. Zij zijn in meerderheid vrouw en alleenstaand. De consultvraag, die meestal niet eenduidig is, heeft in meerderheid betrekking op diagnostiek naar cognitieve achteruitgang. Uit het multidisciplinaire assessment komen relatief veel niet eerder vastgestelde cognitieve, gedrags- en sociale problemen aan het licht, hetgeen bevestigt dat de problematiek van ouderen complex is. Geconcludeerd wordt dat het op een systematische manier in kaart brengen van de problemen van kwetsbare ouderen de kans vergroot dat zij passende zorg krijgen. Vervolgstudies zijn nodig om de effectiviteit en doelmatigheid van deze interventie te evalueren

Assertive community treatment for elderly people with severe mental illness

Background: Adults aged 65 and older with severe mental illnesses are a growing segment of the Dutch population. Some of them have a range of serious problems and are also difficult to engage. While assertive community treatment is a common model for treating difficult to engage severe mental illnesses patients, no special form of it is available for the elderly. A special assertive community treatment team for the elderly is developed in Rotterdam, the Netherlands and tested for its effectiveness.Methods: We will use a randomized controlled trial design to compare the effects of assertive community treatment for the elderly with those of care as usual. Primary outcome measures will be the number of dropouts, the number of patients engaged in care and patient's psychiatric symptoms, somatic symptoms, and social functioning. Secondary outcome measures are the number of unmet needs, the subjective quality of life and patients' satisfaction. Other secondary outcomes include the number of crisis contacts, rates of voluntary and involuntary admission, and length of stay. Inclusion criteria are aged 65 plus, the presence of a mental disorder, a lack of motivation for treatment and at least four suspected problems with functioning (addiction, somatic problems, daily living activities, housing etc.). If patients meet the inclusion criteria, they will be randomly allocated to either assertive community treatment for the elderly or care as usual. Trained assessors will use mainly observational instruments at the following time points: at baseline, after 9 and 18 months.Discussion: This study will help establish whether assertive community treatment for the elderly produces better results than care as usual in elderly people with severe mental illnesses who are difficult to engage. When assertive community treatment for the elderly proves valuable in these respects, it can be tested and implemented more widely, and mechanisms for its effects investigated

A feasibility study of implementing a patient-centered outcome set for pregnancy and childbirth

Background and Aims: Patient-reported outcome and experience measures (PROM and PREM) can facilitate shared decision making and hold potential to improve healthcare quality. However, their adoption in perinatal care is still limited. The International Consortium for Health Outcomes Measurement (ICHOM) developed a Pregnancy and Childbirth (PCB) outcome set, including PROM and PREM questionnaires. We studied the feasibility to use these PROMs/PREMs in Dutch perinatal care, addressing both women's and professionals' perspective. Methods: Patients and professionals in primary and hospital care participated. Women under care at one of five timepoints for PROM/PREM collection of the PCB set (2 during pregnancy, 3 postpartum) were e-mailed a questionnaire and discussed their answers with their obstetric professional the next regular visit. Compliance was recorded. After discussing the PROMs/PREMs, usability and experience were assessed with separate surveys amongst women and professionals. Results: Of 26 women approached, 21 completed and discussed their PROM/PREM questionnaire. Mean questionnaire completion rate was 97%. Average reported time completing the questionnaires was 10 minutes; most women (90%) stated this was acceptable. Women preferred completing questionnaires digitally and discuss their answers with an obstetric professional rather than othe

Family caregivers’ perspectives on their interaction and relationship with people living with dementia in a nursing home:A qualitative study

BACKGROUND: Social interactions are important for people living with dementia in a nursing home. However, not much is known about interactions and relationships between residents and family caregivers and related experiences of family caregivers. We aim to advance the knowledge on how family caregivers interact with people living with dementia in a nursing home and how they maintain or redesign a meaningful connection. METHODS: Qualitative research using interviews with family caregivers (n = 31) to explore perspectives on their interaction and relationship with the person living with dementia. Interviews were held during the reopening of nursing homes after the first COVID-19 lockdown in the Netherlands. In this situation, family caregivers became more aware of their interaction and relationship with the resident, which provided a unique opportunity to reflect on this. The interviews explored the interaction and relationship in a broad sense, not specifically for the COVID-19 situation. Thematic analysis was performed to analyze the data. RESULTS: We were able to identify three key themes reflecting the experiences of family caregivers: (1) changes in the interaction and relationship, (2) strategies to promote connection, and (3) appreciation of the interaction and relationship. From the viewpoint of family caregivers, the interaction and relationship are important for both the resident living with dementia and for themselves, and family caregivers have different strategies for establishing a meaningful connection. Nevertheless, some appear to experience difficulties with constructing such a connection with the resident. CONCLUSIONS: Our results provide a basis for supporting family caregivers in perceiving and establishing mutuality and reciprocity so that they can experience togetherness. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-02922-x