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

Context Elderly persons with psychiatric disorders are less likely than you nger 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 ser iously mentally ill elderly persons is more effective than usual care in di minishing 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 Trea tment 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 underwe nt screening for psychiatric illness, Among those screened, 342 screened po sitive and 603 screened negative. All screen-positive subjects aged 60 year s and older (n=310) and a 10% random sample of screen-negative subjects age d 60 years and older (n=61) were selected for a structured psychiatric inte rview. Eleven subjects moved or died; 245 (82 %) of those who screened posi tive and 53 (88%) of those who screened negative were evaluated to determin e who had a psychiatric disorder. Data were weighted to estimate the preval ence 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 st aff 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 Montgom ery-Asberg Depression Rating Scale (MADRS), a measure of depressive symptom s, 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 case s at the intervention sites had significantly lower (F-1=31.18; P<.001) MAD RS scores (9.1 vs 15.2) and significantly lower (F-1=17.35; P<.001) BPRS sc ores (27.4 vs 33.9) than those at the nontreatment comparison sites. There was no significant difference between the groups in undesirable moves (rela tive risk, 0.97; 95% confidence interval, 0.44-2.17). Conclusions These results indicate that the PATCH intervention was more eff ective than usual care in reducing psychiatric symptoms in persons with psy chiatric disorders and those with elevated levels of psychiatric symptoms.