Assertive community treatment for elderly people with severe mental illness

Area of Science:

• Geriatric Psychiatry
• Mental Health Services Research
• Community Psychiatry

Background:

• Severe mental illness (SMI) affects a growing elderly population (65+) in the Netherlands.
• Many elderly SMI patients face complex challenges and are difficult to engage in treatment.
• Assertive Community Treatment (ACT) is effective for difficult-to-engage SMI patients, but a specialized approach for the elderly was lacking.

Purpose of the Study:

• To evaluate the effectiveness of a specialized Assertive Community Treatment for the Elderly (ACT-E) team.
• To compare ACT-E with care as usual (CAU) for elderly individuals with SMI who are difficult to engage.
• To determine if ACT-E leads to better patient engagement, symptom reduction, and functional improvement.

Main Methods:

• Randomized controlled trial (RCT) design comparing ACT-E with CAU.
• Primary outcomes: dropout rates, engagement in care, psychiatric symptoms, somatic symptoms, social functioning.
• Secondary outcomes: unmet needs, quality of life, patient satisfaction, crisis contacts, admission rates, length of stay.
• Inclusion criteria: age 65+, mental disorder, lack of treatment motivation, multiple functional problems.
• Assessments at baseline, 9 months, and 18 months using observational instruments.

Main Results:

• This section is not available in the provided abstract.

Conclusions:

• The study will determine if ACT-E is superior to CAU for elderly SMI patients who are difficult to engage.
• Findings will inform potential wider implementation and further investigation into the mechanisms of ACT-E.
• This research addresses a critical gap in specialized care for a vulnerable elderly population with severe mental illness.