A randomized trial of early psychiatric intervention in residential care: impact on health outcomes.
BACKGROUND
The prevalence of psychological and behavioral disturbances among older adults living in residential care facilities is high, and it has been shown previously that people with such symptoms have poorer health outcomes. This study was designed to assess the efficacy of an early psychiatric intervention on the 12-month health outcomes of older adults admitted to residential care facilities in Perth, Western Australia. We hypothesized that subjects in the intervention group would have better mental and physical health outcomes than controls.


METHODS
The study was designed as a randomized, single-blinded, controlled trial. All subjects aged 65 years or over admitted to one of the 22/26 participating residential care facilities of the Inner City area of Perth were approached to join the study and were allocated randomly to the intervention or usual care group. Demographic and clinical information (including medications and use of physical restraint) was gathered systematically from all participants at baseline, and at 6 and 12 months. At each assessment, the Geriatric Depression Scale (GDS), the Health of the Nation Outcome Scales for older adults (HoNOS 65+), the Mini-mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were administered. Subjects in the intervention group who screened positive at the baseline assessment for psychiatric morbidity were reviewed within a 2-week period by the Inner City Mental Health Service of Older Adults (ICMHSOA). If clinically appropriate, mental health services were introduced without the involvement of the research team.


RESULTS
One hundred and six subjects and their next of kin consented to participate in the study (53 in each group). Mental health screening and early referral to a psychogeriatric service did not significantly change the average number of medical contacts, self-rated health, use of psychotropic or PRN medication, use of physical restraint, 12-month mortality, or mental health outcomes, as measured by the GDS-15, HoNOS 65+ and NPI (p > 0.05 for all relevant outcomes).


CONCLUSIONS
Systematic mental health screening of older adults admitted to residential care facilities and early clinical intervention does not change 12-month health outcomes. More effective interventions to improve the health outcomes of older adults with psychological and behavioral disturbances admitted to residential care facilities are needed.
Kotynia-English
Ria
R
School of Psychiatry and Clinical Neurosciences, University of Western Australia and Royal Perth Hospital, Perth, Western Australia.
McGowan
Helen
H
Almeida
Osvaldo P
OP
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D015897:Comorbidity; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission; D011594:Psychometrics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D016037:Single-Blind Method; D016019:Survival Analysis; D014904:Western Australia