title: Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness.
abstract: OBJECTIVE
  This report describes 1-, 2-, and 3-year outcomes of a combined psychosocial skills training and preventive healthcare intervention (Helping Older People Experience Success [HOPES]) for older persons with serious mental illness.
  
  
  METHODS
  A randomized controlled trial compared HOPES with treatment as usual (TAU) for 183 older adults (age ≥ 50 years [mean age: 60.2]) with serious mental illness (28% schizophrenia, 28% schizoaffective disorder, 20% bipolar disorder, 24% major depression) from two community mental health centers in Boston, Massachusetts, and one in Nashua, New Hampshire. HOPES comprised 12 months of weekly skills training classes, twice-monthly community practice trips, and monthly nurse preventive healthcare visits, followed by a 1-year maintenance phase of monthly sessions. Blinded evaluations of functioning, symptoms, and service use were conducted at baseline and at a 1-year (end of the intensive phase), 2-year (end of the maintenance phase), and 3-year (12 months after the intervention) follow-up.
  
  
  RESULTS
  HOPES compared with TAU was associated with improved community living skills and functioning, greater self-efficacy, lower overall psychiatric and negative symptoms, greater acquisition of preventive healthcare (more frequent eye exams, visual acuity, hearing tests, mammograms, and Pap smears), and nearly twice the rate of completed advance directives. No differences were found for medical severity, number of medical conditions, subjective health status, or acute service use at the 3-year follow-up.
  
  
  CONCLUSIONS
  Skills training and nurse facilitated preventive healthcare for older adults with serious mental illness was associated with sustained long-term improvement in functioning, symptoms, self-efficacy, preventive healthcare screening, and advance care planning.
authors: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH. Electronic address: sbartels@dartmouth.edu.
authors: Stephen J
authors: SJ
authors: Bartels
authors: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH.
authors: Sarah I
authors: SI
authors: Pratt
authors: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth Psychiatric Research Center, Lebanon, NH; Center for Psychiatric Rehabilitation, Boston University, Boston, MA.
authors: Kim T
authors: KT
authors: Mueser
authors: Department of Psychiatry, Harvard University, Cambridge, MA; Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA.
authors: Brent P
authors: BP
authors: Forester
authors: Dartmouth Psychiatric Research Center, Lebanon, NH.
authors: Rosemarie
authors: R
authors: Wolfe
authors: Schizophrenia Program, Massachusetts General Hospital, Boston, MA.
authors: Corinne
authors: C
authors: Cather
authors: Dartmouth Psychiatric Research Center, Lebanon, NH.
authors: Haiyi
authors: H
authors: Xie
authors: Dartmouth Psychiatric Research Center, Lebanon, NH.
authors: Gregory J
authors: GJ
authors: McHugo
authors: Vinfen, Cambridge, MA.
authors: Bruce
authors: B
authors: Bird
authors: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH.
authors: Kelly A
authors: KA
authors: Aschbrenner
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH.
authors: John A
authors: JA
authors: Naslund
authors: Massachusetts Mental Health Center, Boston, MA.
authors: James
authors: J
authors: Feldman
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D001714:Bipolar Disorder / Q000534:rehabilitation; D003865:Major Depressive Disorder / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D011315:Preventive Medicine / Q000379:methods*; D011618:Psychotic Disorders / Q000534:rehabilitation; D012559:Schizophrenia / Q000534:rehabilitation; D066107:Social Skills; D013997:Time Factors; D016896:Treatment Outcome
keywords: Older adults; healthcare management; integrated care; preventive healthcare; psychosocial skills training; serious mental illness
references: J Clin Psychol. 1995 May;51(3):320-31
references: 7560131
references: Psychol Aging. 1997 Jun;12(2):277-87
references: 9189988
references: Med Care. 2002 Feb;40(2):129-36
references: 11802085
references: Am J Psychiatry. 2005 Mar;162(3):520-9
references: 15741469
references: N Engl J Med. 1988 Jun 30;318(26):1728-33
references: 3374545
references: J Am Geriatr Soc. 2003 Nov;51(11):1571-9
references: 14687386
references: Schizophr Bull. 2000;26(3):631-58
references: 10993403
references: BMJ. 2001 Jan 27;322(7280):204-8
references: 11159616
references: Biometrics. 1986 Dec;42(4):805-20
references: 3814725
references: Am J Geriatr Psychiatry. 2003 Jan-Feb;11(1):17-23
references: 12527536
references: N Engl J Med. 2013 Feb 7;368(6):493-6
references: 23343039
references: Schizophr Res. 2006 Sep;86(1-3):291-9
references: 16814526
references: Psychiatr Rehabil J. 2004 Spring;27(4):375-91
references: 15222149
references: J Clin Psychiatry. 2007 May;68(5):730-7
references: 17503982
references: Am J Geriatr Psychiatry. 2013 Mar;21(3):251-62
references: 23395192
references: J Psychiatr Res. 1975 Nov;12(3):189-98
references: 1202204
references: J Psychiatr Res. 2008 Mar;42(4):320-7
references: 17303168
references: Am J Geriatr Psychiatry. 2013 Mar;21(3):242-50
references: 23395191
references: Community Ment Health J. 1994 Aug;30(4):363-83
references: 7956112
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: Schizophr Bull. 2001;27(2):235-45
references: 11354591
references: Med Care. 1989 Mar;27(3 Suppl):S178-89
references: 2646488
references: J Consult Clin Psychol. 2010 Aug;78(4):561-73
references: 20658812
references: Br J Psychiatry. 1986 Jan;148:1-11
references: 3082403
references: J Aging Soc Policy. 2011 Jul-Sep;23(3):244-57
references: 21740200
references: Behav Cogn Psychother. 2014 Mar;42(2):199-210
references: 23360683
references: Am J Geriatr Psychiatry. 2013 Dec;21(12):1267-76
references: 24206938
references: Community Ment Health J. 2004 Feb;40(1):75-90
references: 15077730
references: Schizophr Bull. 2005 Oct;31(4):922-30
references: 16037481
references: Am J Geriatr Psychiatry. 2003 Nov-Dec;11(6):648-57
references: 14609805