Effectiveness of a nurse-based outreach program for identifying and treating psychiatric illness in the elderly

Psychiatric illness tends to be underdiagnosed and undertreated in elderly individuals, in part owing to inadequate access to proper care. Between March 1993 and April 1996, the authors sought to determine whether a mobile nurse-based outreach program, the Psychogeriatric Assessment and Treatment in City Housing (PATCH) program, was more effective than usual care in reducing levels of depression, other psychiatric symptoms, and the number of undesirable moves (nursing home placements, evictions, and board and care placements) for elderly persons with mental illness. Of 945 residents from 6 urban public housing sites who were screened for mental illness, 245 screen-positive individuals aged 60 years and older and 53 screen-negative controls in the same age group underwent assessment with the Structured Clinical Interview for DSM-III-R disorders to ascertain the presence of psychiatric disorders. Three of the sites (housing 131 individuals who agreed to participate) received the PATCH intervention, which included education of building staff to identify residents with possible mental illness and on-site assessment and treatment by a psychiatric nurse. Usual care was offered at the other 3 sites (housing 167 who agreed to participate). Outcome measures included change in baseline scores at 26 months of follow-up on the Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) as well as number of undesirable moves at follow-up. Follow-up assessments showed that mentally ill patients who received the PATCH intervention had significantly lower scores on the MADRS (9.1 vs. 15.2; p<.001) and the BPRS (27.4 vs. 33.9; p<.001) than patients who received treatment as usual. No differences between treatment groups were found, however, in risk of undesirable moves. The authors conclude that the PATCH intervention was more effective than usual case in identifying and treating elderly psychiatrically ill patients who live in a high-risk environment.