Psychosocial rehabilitation and quality of life for older adults with serious mental illness: recent findings and future research directions

Abstract

Purpose of Review The projected increase of Americans age 65 years and older will have an unprecedented impact on the health care delivery system. As a result, new models to support individuals with serious mental illness (SMI) will become increasingly more important. This selective overview highlights recent reports addressing psychosocial functioning and interventions for older adults with SMI. Recent Findings Recently published descriptive studies suggest that poor functional outcomes and lower quality of life among older people with SMI are strongly associated with social isolation, depression, cognitive impairment, and chronic medical illness. Recent research on psychosocial interventions include evaluations of three different models of skills training, a supported employment intervention, and cognitive remediation. This research establishes psychosocial rehabilitation as feasible and potentially effective in improving functioning and quality of life in older adults with SMI. Summary Several important directions for future research focused on older adults with SMI are suggested by this overview. They include: individually tailored rehabilitation, interventions that optimize social integration and decrease depressive symptoms, techniques that blend cognitive remediation with vocational rehabilitation, and integration of health promotion with psychosocial rehabilitation.

Integrated Psychological Therapy: Effectiveness in Schizophrenia Inpatient Settings Related to Patients' Age

“…Recent reviews of published data on the rehabilitation goals for older people with serious mental illness summarized that poor outcome in social functioning and lower quality of life are strongly associated with social isolation, depression, cognitive impairment, and chronic medical illness. 1,2 The authors concluded that specific interventions are needed with regard to these specific features associated with social functioning and quality of life in older patients. Interventions should enhance social integration and involvement in meaningfulness activities and should diminish depressive symptoms.…”

“…1 Therefore, research focusing on the impact of the age on schizophrenia features as well as on the successful treatment of these features becomes important. During the last decades, a large bulk of data was published addressing younger people suffering from schizophrenia, but the needs of older schizophrenia patients were often neglected.…”

Directions for Future Patient-Centered and Comparative Effectiveness Research for People With Serious Mental Illness

“…And with the "baby boom" generation now reaching age 65, the challenges and costs of treating the growing numbers of older adults with serious mental illnesses should be a major focus of patient-centered research and mental health service delivery systems. 517,521 Areas ripe for CER and PCOR to improve services to this population include (1) identifying older adults with serious mental illnesses in need of services, (2) engaging them in care, (3) determining the most effective interventions (both pharmacological and psychosocial) for this age group, (4) identifying the patient-centered outcomes valued by this group, and (5) determining how to best deliver interventions to achieve optimal patient-centered and clinical outcomes.…”

“…525 Mental health treatment in nursing homes is often substandard, 518 and institutionalization is associated with worse health status, decreased availability of family supports, more severe overall symptom ratings, greater cognitive impairment, more severe functional deficits, more problem behaviors, more severe medical problems, and fewer social supports. 521 Given this, it is imperative that the mental health delivery system better understand who is a candidate for institutional care and who might be better served in other settings. Despite popular misconceptions, aging with a serious mental illness is not necessarily associated with a decline in independent functioning or with a need for institution-based long-term care.…”

“…There is a growing literature, however, showing promising psychosocial interventions that have been adapted or developed and evaluated for use with middle-aged and older adults. 515,516,519,521,523 Bartels and Pratt 521 reviewed psychosocial rehabilitation interventions for older adults with serious mental illnesses and identified several important areas for future CER and PCOR. First, many of the published psychosocial rehabilitation interventions are group based, and there is a need for comparisons of those approaches with individual interventions that target the specific needs and preferences of the consumer.…”