Psychosocial Rehabilitation in Older Adults with Serious Mental Illness: A Review of the Research Literature and Recommendations for Development of Rehabilitative Approaches

Current Opinion in Psychiatry

Pratt

2009

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.

Section: Psychosocial Rehabilitation In Older Adults With Serious Menmentioning

confidence: 99%

“…Pratt and colleagues [12**] reviewed psychosocial rehabilitation in older adults with SMI. This review included a description of three skills training interventions that hold promise for improving the health and functioning of older adults with SMI.…”

Section: Psychosocial Rehabilitation In Older Adults With Serious Menmentioning

confidence: 99%

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

Current Opinion in Psychiatry

Pratt

2009

“…However, most psychiatric rehabilitation approaches have been developed for the younger population. It is critical that psychosocial interventions such as social skills training be adapted to the special needs of this aging population in order to maximize the quality of their lives and to sustain their ability to live in the community (Pratt, Van Citters, Mueser, & Bartels, 2008). Second, age-associated declines in cognitive functioning and associated impairments in psychosocial functioning in schizophrenia (Bartels, Mueser, & Miles, 1997; Harvey et al, 2000) underscore the importance of evaluating the contribution of cognitive impairment to social skills, as well as exploring whether gender differences persist into old age.…”

mentioning

confidence: 99%

Neurocognition and social skill in older persons with schizophrenia and major mood disorders: An analysis of gender and diagnosis effects

Mueser

Pratt

Journal of Neurolinguistics

et al. 2010

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Effective social interactions necessary for getting affiliative and instrumental needs met require the smooth integration of social skills, including verbal, non-verbal, and paralinguistic behaviors. Schizophrenia is characterized by prominent impairments in social and role functioning, and research on younger individuals with the illness has shown that social skills deficits are both common and distinguish the disease from other psychiatric disorders. However, less research has focused on diagnostic differences and correlates of social skills in older persons with schizophrenia. To address this question, we examined diagnostic and gender differences in social skills in a community-dwelling sample of 183 people older than age 50 with severe mental illness, and the relationships between social skills and neurocognitive functioning, symptoms, and social contact.Individuals with schizophrenia had worse social skills than those with bipolar disorder or major depression, with people with schizoaffective disorder in between. Social contact and cognitive functioning, especially executive functions and verbal fluency, were strongly predictive of social skills in people with schizophrenia and schizoaffective disorder, but not those with mood disorder. Other than blunted affect, symptoms were not predictive of social skills in either the schizophrenia spectrum or the mood disorder group. Older age was associated with worse social skills in both groups, whereas female gender was related to better skills in the mood disorder group, but not the schizophrenia group. The findings suggest that poor social skills, which are related to the cognitive impairment associated with the illness, are a fundamental feature of schizophrenia that persists from the onset of the illness into older age. Keywords NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptImpaired language skill is a characteristic feature of schizophrenia that has long been thought to contribute to the severe functional disability associated with the disorder (Bleuler, 1911(Bleuler, /1950. The broader construct of social skills refers to a complex set of behaviors and perceptual abilities, including both verbal and nonverbal communication behaviors, that are necessary for successful role performance, interpersonal functioning, and gratification of needs in adulthood (Liberman et al., 1986). Conceptualizing communication behavior in terms of social skills that can be broken down into constituent elements has proven useful in the development of interventions for improving social functioning in schizophrenia (Bellack, Mueser, Gingerich, & Agresta, 2004), other psychiatric disorders (Liberman, DeRisi, & Mueser, 1989), and non-psychiatric populations (Shapiro, 2004). These social skills training interventions involve the systematic teaching of skills based on the principles of modeling, behavioral rehearsal, positive reinforcement, and shaping.Research on social skills has often employed simulated social interactions, or role-play tests, in wh...

“…These approaches, and other models specifically focusing on psychosocial skills training,25–30 hold promise for potentially decreasing the disproportionate nursing home placement of older persons with schizophrenia. Future models for the aging population of persons with serious mental illness will benefit from interventions aimed at promoting independence, community tenure, and opportunities that enhance quality of life.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Nursing Home Admission Among Middle Aged and Older Adults With Schizophrenia

Andrews

The American Journal of Geriatric Psychiatry

Xie

et al. 2009

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Objective-Cross-sectional data indicate that persons with serious mental illness have increased risk of institution-based care, yet little is known about the long-term course of nursing home placement for persons with schizophrenia. This study describes nursing home entrance over a 10-year period among community residing Medicaid enrollees with schizophrenia compared with Medicaid enrollees with no mental illness.Methods-The authors analyzed claims of 7,937 New Hampshire Medicaid beneficiaries aged 40 and older. Claims were followed annually from 1996 to 2005 to determine nursing home admission. Schizophrenia was identified from International Classification of Diseases: 9th Edition codes and used to model nursing home admission controlling for medical severity, physical disability, sex, and age. Cox proportional hazard models were run for the entire sample and then separately for middleaged (40-64 years) and older-aged (65 years and older) subgroups.Results-Persons with schizophrenia enter nursing homes earlier (median age 65) than persons with no mental illness (median age: 80). The greatest relative disparity occurs at middle age (40-64 years), where nursing home admission risk was 3.90 (95% confidence interval = 2.86-5.31) times greater for persons with schizophrenia than for persons with no mental illness.Conclusions-Middle-aged persons with schizophrenia have almost four times greater likelihood of early institutionalization in nursing homes compared with their same age peers with no mental illness. Efforts to prevent/reduce unwarranted nursing home admission among persons with schizophrenia should focus on health status in the fifth decade of life. KeywordsSchizophrenia; Medicaid; nursing home; older adults Over the past 20 years, a series of laws and court decisions have been enacted to reduce unwarranted institutionalization of persons with mental illness. The aim of these regulations (e.g., the Omnibus Budget Reconciliation Act of 1987, the Preadmission Screening and Annual Resident Review, and the Olmstead decision) is to ensure the quality and appropriateness of These rulings are associated with an overall decline in nursing home admissions for persons with serious mental illness. 3 However, for many older adults, nursing homes persist as a major provider of long-term, institution-based psychiatric care. 2 Studies indicate that a majority of nursing facility residents have a mental disorder or clinically significant psychiatric symptoms, 1,2 even though the quality of mental healthcare in many of these institutions remains poor and access to treatment is limited. 1,4 Affordable and adequate housing has been shown to improve quality of life and overall functioning among persons with long-term mental illness. 5,6 Many older adults express a desire to remain in their own residence 6,7 and consider nursing homes the last resort. 8 Given the high cost of nursing home care, particularly for individuals with schizophrenia, 9 preventing unwarranted institutionalization of persons with mental illness b...