title: The effectiveness of assertive community treatment for elderly patients with severe mental illness: a randomized controlled trial.
abstract: BACKGROUND
  Due to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults.
  
  
  METHODS
  In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients' psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat.
  
  
  RESULTS
  Of the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables.
  
  
  CONCLUSIONS
  These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully.
  
  
  BACKGROUND
  NTR1620.
authors: Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands. j.stobbe@erasmusmc.nl.
authors: Jolanda
authors: J
authors: Stobbe
authors: André I
authors: AI
authors: Wierdsma
authors: Rob M
authors: RM
authors: Kok
authors: Hans
authors: H
authors: Kroon
authors: Bert-Jan
authors: BJ
authors: Roosenschoon
authors: Marja
authors: M
authors: Depla
authors: Cornelis L
authors: CL
authors: Mulder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003156:Community Mental Health Services; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D012107:Research Design; D016896:Treatment Outcome