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

Peter V. Rabins, Betty E Black, Robert Roca, Pearl German, Marsden McGuire, Beatrice Robbins, Rebecca Rye, Larry Brant

Research output: Contribution to journalArticle

Abstract

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; P1 = 17.35; P

Original languageEnglish (US)
Pages (from-to)2802-2809
Number of pages8
JournalJournal of the American Medical Association
Volume283
Issue number21
StatePublished - Jun 7 2000

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Psychiatry
Nurses
Geriatric Psychiatry
Depression
Housing for the Elderly
Public Housing
Brief Psychiatric Rating Scale
Behavioral Symptoms
Baltimore
Mentally Ill Persons
Nursing Homes
Mental Disorders
Young Adult
Mental Health
Therapeutics
Outcome Assessment (Health Care)
Interviews

ASJC Scopus subject areas

  • Medicine(all)

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Effectiveness of a nurse-based outreach program for identifying and treating psychiatric illness in the elderly. / Rabins, Peter V.; Black, Betty E; Roca, Robert; German, Pearl; McGuire, Marsden; Robbins, Beatrice; Rye, Rebecca; Brant, Larry.

In: Journal of the American Medical Association, Vol. 283, No. 21, 07.06.2000, p. 2802-2809.

Research output: Contribution to journalArticle

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abstract = "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; P1 = 17.35; P",
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