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      Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies

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          Abstract

          Background

          The vast majority of older people with mental illness prefer to live independently in their own homes. Barriers caused by the health care system often prevent adequate, adapted treatments. With regard to the increasing ageing of the population, the determination of effective, age-appropriate service models for elderly patients with mental illness is clearly required. The aim of this review is to examine and to evaluate multidisciplinary psychogeriatric treatment models that include home visits, particularly with regard to the effects on psychiatric symptoms, social and mental health rehabilitation and quality of life.

          Methods

          A systematic review was carried out of empirical studies with participants who were diagnosed with a mental illness according to ICD-10, aged 60 years or older, and who were living at home. The inclusion criteria comprised a duration of intervention of at least 12 weeks and a minimum of two interventions and domiciliary visits delivered by a multidisciplinary team. The online databases Medline, PsychInfo, Web of Science, Cochrane Register of Controlled Trials, and Google Scholar, as well as hand search, were used to search for relevant studies published between 1996 and 2016. An additional search was performed for studies published between 2016 and 2019. After removing duplicates, abstracts were screened and the remaining articles were included for full-text review.

          Results

          Of the 3536 records discovered in total, 260 abstracts appeared to be potentially eligible. Of these, 30 full-text articles were assessed for eligibility. For the additional search 415 records and abstracts were screened and 11 articles were read full text. Finally, only three studies fully met the inclusion criteria for this review. The results indicate that psychogeriatric home treatment is associated with significant improvements of psychiatric symptoms and psychosocial problems, fewer admissions to hospital and nursing homes, as well as lower costs of care.

          Conclusions

          Psychogeriatric home treatment has positive effects on older people with mental illness. However, these findings are based upon a small number of studies. The need for further research, especially to specify the effective factors in psychogeriatric home treatment, is clearly indicated.

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          Most cited references36

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          Screening performance of the 15-item geriatric depression scale in a diverse elderly home care population.

          To empirically evaluate the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15); determine the optimal cutoff points and screening performance for the detection of major depression; and examine differential item functioning (DIF) to determine the variability of item responses across sociodemographics in an elderly home care population. A secondary analysis of data collected from a random sample study. Homebound subjects newly admitted over a 2-year-period to a large visiting nurse service agency in Westchester, New York. Five hundred twenty-six subjects over age 65, newly admitted to home care for skilled nursing. Major depression was diagnosed using both patient, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and best estimate procedures. Self-report measures included the GDS-15, activities of daily living (ADL), instrumental ADL, and pain intensity. Cognitive impairment was assessed using the Mini-Mental State Examination and medical morbidity using the Charlson Comorbidity Index. Optimal cutoff (5) yielded sensitivity 71.8% and specificity of 78.2%, however, the accuracy of the GDS-15 was not influenced by severity of medical burden. Persons with a cluster of ailments were twice as likely (Adj odds ratio = 2.47; 95% confidence interval = 1.49-4.09) to be diagnosed with depression. DIF analyses revealed no variability of item responses across sociodemographics. Main findings suggest that the accuracy of the GDS-15 was not influenced by severity of clinical or functional factors, or sociodemographics. This has broad implications suggesting that the very old, ill, and diverse populations can be appropriately screened for depression using the GDS-15.
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            Physical and mental health of homebound older adults: an overlooked population.

            There are currently more than 38.9 million people aged 65 an older in the United States. Up to 3.6 million of these people are considered housebound and in need of home-based care. Although homebound status is not defined specifically, with a broad range of disability levels, it is evident that people who are homebound suffer from a multitude of medical and psychiatric illnesses. This review examines the current literature to identify the specific physical and psychiatric factors most responsible for older adults becoming and remaining housebound. Homebound older adults suffer from metabolic, cardiovascular, cerebrovascular, and musculoskeletal diseases, as well as from cognitive impairment, dementia, and depression, at higher rates than the general elderly population. The information in this review will explain the specific types of care the homebound population needs and discuss the care that could help ease their suffering and delay their entry into a nursing home or hospital. © 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.
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              A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the Geriatric Mental State Schedule. I. Development and reliability.

              A standardized, semi-structured interview for examining and recording the mental state in elderly subjects is described. It allows the classification of patients by symptom profile and can demonstrate changes in that profile over time. It is believed that good reliability is demonstrated between psychiatric raters both for psychiatric diagnosis made on the basis of the schedule findings and for individual items. The Geriatric Mental State Schedule (GMS) consists mainly of items from the eighth edition of the PSE (Wing et al. 1967), together with additional items from the PSS (Spitzer et al. 1964), and extra sections dealing with disorientation and other cognitive abnormalities. Modifications have been introduced to facilitate interviewing elderly subjects.
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                Author and article information

                Contributors
                guenter.klug@gfsg.at
                psz.hasnerplatz@gfsg.at
                gerhard.hermann@gfsg.at
                monika.singer@gfsg.at
                guenter.schulter@uni-graz.at
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                3 December 2019
                3 December 2019
                2019
                : 19
                : 382
                Affiliations
                [1 ]Society for Mental Health Promotion, Plüddemanngasse 45, A-8010 Graz, Austria
                [2 ]Society for Mental Health Promotion, Hasnerplatz 4, A-8010 Graz, Austria
                [3 ]Society for Mental Health Promotion, Plüddemanngasse 33, A-8010 Graz, Austria
                [4 ]ISNI 0000000121539003, GRID grid.5110.5, Department of Psychology, Biological Psychology Unit, , University of Graz, ; Universitätsplatz 2, A-8010 Graz, Austria
                Author information
                http://orcid.org/0000-0001-7146-2630
                Article
                2369
                10.1186/s12888-019-2369-z
                6889722
                31796012
                d0114445-c200-49f6-a268-6252cdaaccd5
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 June 2019
                : 20 November 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Clinical Psychology & Psychiatry
                mental illness,multidisciplinary psychogeriatric home treatment,elderly,community mental health,systematic review

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