Assertive Community Treatment for Elderly patients with Severe Mental Illness

__Abstract__ Er bestaat tot op heden geen specifiek ACT team voor ouderen. Effectstudies naar interventies aan ouderen met complexe psychiatrische problematiek is sowieso schaars. In 2008 is in Rotterdam door BavoEuropoort een ACT team speciaal voor ouderen gestart (60+), aan deze nieuwe methode van werken is een onderzoek gekoppeld; ACT voor ouderen. Doel van het onderzoek is het evalueren van de effecten van ACT bij ouderen, in vergelijking met Care As Usual (CAU). Dit gebeurt door middel van een gerandomiseerde klinische trial, waarbij sprake is van pre-randomisatie (Zeelen design) en Routine Outcome Monitoring. Er zijn onderzoeksvragen opgesteld over het psychosociale functioneren en het psychiatrische beeld van de patiënt. Daarnaast wordt gekeken naar het aantal patiënten wat in zorg blijft, het aantal (gedwongen) opnamen en naar de tevredenheid over de hulpverlening en de subjectieve beleving van kwaliteit of leven. De resultaten van dit onderzoek leveren inzichten op in de werkzaamheid van ACT bij ouderen en of deze methodiek meerwaarde heeft ten opzichte van standaardzorg. De implementatie van het onderzoek zal leiden tot een toename van de kennis over de diverse vormen van hulpverlening aan ouderen met ernstige psychiatrische problematiek en zou kunnen leiden tot een evidence-based interventie aan genoemde doelgroep

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

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