Mohamed Somaia, Neale Michael S, Rosenheck Robert
New England Mental Illness Research, Education and Clinical Center, VA Connecticut Health Care System, 950 Campbell Ave., West Haven, CT 06516, USA.
Am J Geriatr Psychiatry. 2009 Aug;17(8):671-81. doi: 10.1097/JGP.0b013e3181a88340.
There is a growing need for information on evidence-based practices that may potentially address needs of elderly people with severe mental illness (SMI), and more specifically on community-based services such as assertive community treatment (ACT).
This study examines national evaluation data from fiscal year 2001-2005 from Veterans Affairs Mental Health Intensive Case Management (MHICM) program (N = 5,222), an ACT-based service model, to characterize the age distribution of participants and the distinctive needs, patterns of service delivery, and treatment outcomes for elderly veterans.
Altogether, 24.8% of participants were 55-64 years; 7.4% 65-74 years; and 2.8% were older than 75. Veterans over 75 formed a distinct subgroup that had a later age of onset of primarily nonpsychotic illnesses without comorbid substance abuse and had experienced more limited lifetime hospital treatment than younger participants. Older veterans were less symptomatic and more satisfied with their social relationships than younger clients. They mostly live independently or in minimally restrictive housing, but they received less recovery-focused services and more crisis intervention and medical services. They thus do not appear to be young patients with SMI who have aged but rather constitute a distinct group with serious late-onset problems. It is possible that MHICM services keep them in the community and avoid costly nursing home placement while providing a respite service that reduces family burden.
These data highlight the unique characteristics of older veterans receiving ACT-like services and the need to focus greater attention on recovery-oriented services as well as community support for this subgroup.
对于基于证据的实践信息的需求日益增长，这些实践可能潜在地满足患有严重精神疾病（SMI）的老年人的需求，更具体地说，是关于诸如积极社区治疗（ACT）等基于社区的服务的信息需求。
本研究检查了2001 - 2005财政年度退伍军人事务部心理健康强化个案管理（MHICM）项目（N = 5222）的全国评估数据，该项目是一种基于ACT的服务模式，以描述参与者的年龄分布以及老年退伍军人的独特需求、服务提供模式和治疗结果。
总体而言，24.8%的参与者年龄在55 - 64岁之间；7.4%在65 - 74岁之间；2.8%年龄超过75岁。75岁以上的退伍军人形成了一个独特的亚组，他们主要患有非精神病性疾病的发病年龄较晚，没有合并药物滥用，并且与年轻参与者相比，其终身住院治疗经历更为有限。老年退伍军人的症状较轻，对其社会关系的满意度高于年轻客户。他们大多独立生活或居住在限制最小的住房中，但他们接受的以康复为重点的服务较少，而接受的危机干预和医疗服务较多。因此，他们似乎不是患有SMI的老年患者，而是构成了一个具有严重迟发性问题的独特群体。MHICM服务有可能使他们留在社区，避免昂贵的养老院安置，同时提供减轻家庭负担的临时服务。
这些数据突出了接受类似ACT服务的老年退伍军人的独特特征，以及需要更加关注以康复为导向的服务以及对该亚组的社区支持。
