Schizophrenia Clinical Trial
Official title:
Rehabilitation and Health Care for Elderly With SMI
This study will evaluate the effectiveness of a health management and supported rehabilitation intervention in treating serious mental illnesses in older people.
This randomized, controlled study will evaluate the effectiveness of a health management
(HM) and supported rehabilitation (SR) intervention for 180 older persons (age 50+) with
serious mental illness. We will address the following specific aims and hypotheses:
Specific Aim 1- To compare the effectiveness of SR/HM to UC in improving independent living
skills and health management. We hypothesize that compared to older individuals with SMI
receiving UC, individuals receiving SR/HM will have better independent living skills and
health management, evidenced by:
1. Better community living skills and better social skills based on performance-based
measures and self-reports of functioning, and
2. Better medication management skills based on performance-based and self-report measures
and greater use of preventive and routine primary health care (including annual
check-ups with a primary care provider and participation in preventive health care).
Specific Aim 2- To compare the effectiveness of SR/HM to UC in decreasing the use of
high-cost acute and long-term institution-based services. We hypothesize that compared to
older individuals with SMI receiving UC, individuals receiving SR/HM will use fewer high
cost services, including emergency room visits, acute hospitalizations, and nursing home
care. In addition, the reduced use of high cost institution-based services will be
associated with better independent living skills and health management practices resulting
from the SR/HM intervention.
We will also evaluate the following secondary, exploratory hypotheses:
1. The SR/HM intervention will be associated with better general health status.
2. The effectiveness of SR/HM in improving living skills and community functioning will be
greatest for individuals with low levels of cognitive impairment.
In addition, we will describe outpatient service utilization for SR/HM and UC models within
each study site in order to present a more comprehensive account of services used by study
participants.
Little is known about how to provide effective rehabilitation and health management services
to older persons with serious mental illness (SMI) to decrease the use of high-cost
institution-based services. To address this need, we developed a supported rehabilitation
and health management (SR/HM) intervention for older persons with SMI that addresses
functioning in two areas essential for preventing hospitalizations and long-term
institutional care: (1) enhanced independent living skills and (2) improved health
management. The supported rehabilitation (SR) component consists of skills training aimed at
improving competence in everyday functioning, including community living skills and social
skills. The health management (HM) component consists of training in health management
skills and health case management by nurses who monitor and facilitate routine preventive
and acute health care. Results from a pilot study indicate that SR/HM is effective in
improving independent living skills and health management for older persons with SMI.
The aims of this study are to test the effectiveness of the SR/HM intervention in improving
the functioning and health care of older persons with SMI and in reducing the use of high
cost, acute and long-term institution-based care. The proposed research will compare the
SR/HM intervention to usual care (UC) in a randomized, controlled study of 180 individuals
age 60 and older with SMI living in the community.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind, Primary Purpose: Treatment
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