Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.
OBJECTIVE
The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase.


METHODS
To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up.


RESULTS
Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37-.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill.


CONCLUSIONS
The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program.
Mueser
Kim T
KT
Department of Psychiatry, Dartmouth Psychiatric Research Center, Dartmouth Medical School, 105 Pleasant Street, Concord, NH 03301, USA. kim.t.mueser@dartmouth.edu
Pratt
Sarah I
SI
Bartels
Stephen J
SJ
Swain
Karin
K
Forester
Brent
B
Cather
Corinne
C
Feldman
James
J
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D019090:Case Management; D003131:Combined Modality Therapy; D017281:Cost of Illness; D019033:Delivery of Health Care, Integrated; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D020377:Self Efficacy; D012737:Sex Factors; D012917:Social Adjustment; D012919:Social Behavior