Attitudes and Beliefs on Aging Among Middle-Aged and Older Adults With Serious Mental Illness.

Older adults with serious mental illness (SMI) experience increased medical comorbidities, disability, and early mortality, but little is known about how they perceive the process of aging. This study explored attitudes and beliefs about aging among n = 20 middle aged and older adults (M = 59.8 years; range 47-66) with SMI in a state psychiatric hospital. We conducted semistructured interviews using the Attitudes to Ageing Questionnaire (AAQ) and analyzed narrative accounts using a grounded theory approach. The mean scores of overall attitudes toward aging and of the subscale of perception of psychological growth were both positive compared to a neutral rating (p = 0.026 and p = 0.004, respectively). Study participants rated their experience on the subscales of psychosocial loss and physical health change as neutral. Despite substantial psychiatric, medical, and functional disabilities, older adults with SMI in this study of psychiatric inpatients perceived the process of aging as generally positive, suggesting resilience and potential positive emotional growth in older age.

Treatment of late-life mental disorders in primary care: we can do a better job.

Health care services provided to older adults today are not as effective as they should be. The quality of care for late-life mental disorders often falls short of desired standards. The growth of the elderly population makes it imperative for the health care system to address late-life mental disorders more effectively. Intervention strategies based in primary care settings show the most promise, but effectiveness will depend on solving the geriatric psychiatry workforce crisis. Collaborative care is one promising model for improving geriatric mental health care delivery in primary care. Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers. Public policy should reflect the essential role of psychiatry in geriatrics and promote the integration of geriatric psychiatry with primary care.

Models of mental health services in nursing homes: a review of the literature.

OBJECTIVE: The authors review the research literature on models and outcomes of extrinsic mental health services in nursing homes and summarize the data on current practices in this area. Extrinsic mental health services are those delivered in the nursing home by specialists who are not full-time staff of the nursing home. METHODS: English-language articles providing descriptive and research reports on models and outcomes of extrinsic mental health services in nursing homes were identified through a comprehensive search of peer-reviewed journals, using MEDLINE and psychological literature databases. The research methods of the reports were also noted. RESULTS: Three primary models of mental health service delivery were identified: psychiatrist-centered, nurse-centered, and multidisciplinary team models. Uncontrolled observational studies suggested that mental health services may result in improved clinical outcomes and less use of acute services. However, few well-designed controlled intervention studies have been conducted. Education and training appeared to improve staff members' knowledge and performance and to decrease turnover. The least effective model involved traditional consultation-liaison service in which a lone clinician provided a one-time, written consultation on an as-needed basis. Multidisciplinary team approaches were favored as preferred service models. CONCLUSIONS: Few studies using an experimental design have examined the outcomes of mental health services in nursing homes. Program descriptions and uncontrolled outcome studies suggest that preferred practice includes the routine presence of qualified mental health clinicians in the nursing home, that optimal services are interdisciplinary and multidimensional, and that the most effective interventions blend innovative approaches to training and education with consultation and feedback on clinical practices.