Van Citters Aricca D, Bartels Stephen J
New Hampshire-Dartmouth Psychiatric Research Center, 2 Whipple Place, Lebanon, NH 03766, USA.
Psychiatr Serv. 2004 Nov;55(11):1237-49. doi: 10.1176/appi.ps.55.11.1237.
Psychiatric outreach services that provide mental health assessment and treatment to older adults in their homes or communities are widely promoted as improving access and outcomes for older adults. However, a systematic review of the efficacy of these services has not been done. This review evaluates the evidence base for the effectiveness of outreach services for older adults with mental illness in noninstitutional community settings. End points of interest include the ability of the outreach program to increase access to mental health services and improve psychiatric outcomes.
MEDLINE, CINAHL, PsycINFO, and Web-of-Science databases were searched for articles in English that were indexed through May 2004. Studies were included if they evaluated face-to-face psychiatric services provided to adults aged 65 and older with mental illness and if they were randomized controlled trials, quasi-experimental outcome studies, uncontrolled cohort studies, or comparisons of two or more interventions. Articles were excluded that evaluated interventions that were provided in institutional settings or that focused on persons with dementia or their caregivers.
Fourteen studies matched all the inclusion criteria. Two studies (one controlled prospective study and one study that used a comparison group) found support for the use of gatekeepers-nontraditional referral sources-in identifying socially isolated older adults with mental illness. Twelve studies (five randomized controlled trials, one quasi-experimental study, and six uncontrolled cohort studies) found that home and community-based treatment of psychiatric symptoms were associated with improved or maintained psychiatric status. All randomized controlled trials reported improved depressive symptoms, and one reported improved overall psychiatric symptoms.
Limited data supported the effectiveness of outreach services in identifying isolated older adults with mental illness. A more substantial evidence base indicated that home-based mental health treatment is effective in improving psychiatric symptoms. Studies are needed that apply more rigorous methods evaluating the efficacy of case identification models and subsequent treatment for older persons with a variety of psychiatric diagnoses.
为老年人在其家中或社区提供心理健康评估和治疗的精神科外展服务被广泛宣传为可改善老年人获得服务的机会及治疗效果。然而，尚未对这些服务的疗效进行系统评价。本综述评估了在非机构化社区环境中为患有精神疾病的老年人提供外展服务有效性的证据基础。感兴趣的终点包括外展项目增加获得心理健康服务机会及改善精神科治疗效果的能力。
检索了MEDLINE、CINAHL、PsycINFO和科学网数据库中截至2004年5月索引的英文文章。纳入的研究需评估为65岁及以上患有精神疾病的成年人提供的面对面精神科服务，且为随机对照试验、准实验性结局研究、非对照队列研究或两种或更多干预措施的比较。排除评估在机构环境中提供的干预措施或关注痴呆症患者及其照料者的文章。
14项研究符合所有纳入标准。两项研究（一项对照前瞻性研究和一项使用对照组的研究）发现，使用守门人——非传统转诊来源——在识别社会孤立的患有精神疾病的老年人方面有支持依据。12项研究（5项随机对照试验、1项准实验研究和6项非对照队列研究）发现，基于家庭和社区的精神症状治疗与精神状态改善或维持有关。所有随机对照试验均报告抑郁症状改善，一项报告总体精神症状改善。
有限的数据支持外展服务在识别孤立的患有精神疾病的老年人方面的有效性。更大量的证据表明，基于家庭的心理健康治疗在改善精神症状方面是有效的。需要开展研究，应用更严格的方法评估病例识别模型以及对患有各种精神科诊断的老年人后续治疗的疗效。
