Two Year Follow-Up Study of an Outreach Program in Geriatric Psychiatry^*

Abstract

In Canada and the U.S. the percentage of elderly people is increasing and more funds are being spent on institutional programs. Yet many are not so impaired that they cannot be looked after by relatives. A number of community outreach programs are available. From an inpatient psychogeriatric unit in Hamilton Provincial Hospital an outreach program is described. A follow-up study was done during a 2 year period by contacting the referral sources. The 24% who had been admitted were compared with the 75.9% who remained in the community. While patients' relatives and referring sources were mostly pleased with the assessments, and those patients not admitted were less institutionalized, those admitted with affective disorder showed a higher recovery rate than those remaining in the community. The total number admitted to hospital showed a lower mortality rate than those not admitted, even though the latter three considered less mentally ill because of the criteria for admission to the hospital.

A psychogeriatric community outreach service: Description and evaluation

“…Next were patients with major depression, with a mean change of 1 .O. However, this change was the only one that was not statistically significant, a finding which concurs with that of Houston (1983), who found that patients with affective disorders were relatively resistant to community treatment. Alternatively, since depression in the elderly is often slower to respond to treatment than depression in younger people, our three-month assessment may have been too early to identify late responders.…”

“…The results of other studies are more encouraging (Houston, 1983;Levy, 1985;Moreno and Wile, 1989; Wasylenki e t al., 1984). There is a consensus that comprehensive community care of psychogeriatric patients minimizes unnecessary admission to hospital, and that high levels of satisfaction with such services are reported by carers.…”

“…There is a consensus that comprehensive community care of psychogeriatric patients minimizes unnecessary admission to hospital, and that high levels of satisfaction with such services are reported by carers. However, Houston (1983) found that patients with affective disorders tended to do better with hospital rather than community treatment. Overall, research findings suggest that it is premature to assume the general superiority of community over hospital care for all psychogeriatric patients.…”

What is the effectiveness of acute hospital treatment of older people with mental disorders?

“…A non-randomized retrospective Canadian study compared the 2-year outcome of patients treated by a psychogeriatric outreach service with those admitted to a psychogeriatric unit. Older people with affective disorders managed in the community had a poorer outcome than the hospitalized group, although there was less institutionalization of the community cases (Houston, 1983). These findings should be interpreted with great caution because of the study's methodological shortcomings.…”