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Long-Term Outcomes of a Randomized Trial of Integrated Skills Training and Preventive Healthcare for Older Adults with Serious Mental Illness
Open accessAbstract
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.Conclusion 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.
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“A greater proportion of HOPES participants received flu shots, hearing tests, eye exams, mammograms, PAP smears, and completed advanced directives than the usual care recipients.”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [281]
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Metadata
- Authors
- Bartels, S. J., Pratt, S. I., Mueser, K. T., Forester, B. P., Wolfe, R., Cather, C., Xie, H., McHugo, G. J., Bird, B., Aschbrenner, K. A., Naslund, J. A., & Feldman, J.
- Affiliations
- Dartmouth College (US)
- Harvard University (US)
- Dartmouth Psychiatric Research Center (US)
- Massachusetts General Hospital (US)
- Massachusetts Mental Health Center (US)
- Corresponding author
- Bartels, Stephen J.
- ORCID
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 22
- Issue
- 11
- Pages
- 1251-1261
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC3836872
- OpenAlex
- W2075449875
- Cited by
- 138
- References
- 44
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 6 · 2023: 3 · 2022: 11 · 2021: 9 · 2020: 44 · 2019: 8 · 2018: 7 · 2017: 20 · 2016: 3 · 2015: 5 · 2014: 7
- FWCI
- 4.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01 MH62324)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- older adults, severe mental illness, psychosocial skills training, preventive medicine, nurse-led care, community living skills, self-efficacy, advance care planning, schizophrenia, bipolar disorder, major depressive disorder, long-term outcomes, community mental health services
- MeSH terms
- Activities of Daily Living, Mental Disorders, Bipolar Disorder, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Preventive Medicine, Psychotic Disorders, Schizophrenia, Time Factors, Treatment Outcome, Social Skills
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