Am J Geriatr Psychiatry 2002 Jul-Aug;10(4):437-46. Suicidality in older African Americans: findings from the EPOCH study. Cook JM, Pearson JL, Thompson R, Black BS, Rabins PV. University of Pennsylvania and Philadelphia VA Medical Center, 19104, USA. cook_j@mail.trc.upenn.edu
The authors examined the current frequency of suicidality and associated characteristics in a sample of 835 African-American older adult residents of six urban public housing developments who consented to participate in an intervention trial of mobile outreach. The frequency of passive and active suicidal ideation was 2.5% and 1.4%, respectively. Characteristics of individuals with both active and passive suicidality included elevated anxiety, social dysfunction, somatic symptoms, low social support, lack of a confidant, and low religiosity. Characteristics of those with passive, but not active, ideation also included older age, lower levels of education, elevated depressive symptoms, poorer cognitive functioning, and having recently discussed emotional problems with a healthcare provider. The characteristics of those reporting active, but not passive, ideation included having a history of mental health treatment and reporting no instrumental support. Multivariate analyses indicated that depression and religiosity were uniquely associated with passive suicidal ideation, and life satisfaction and religiosity were uniquely associated with active suicidal ideation. The authors discuss implications of these findings and offer suggestions for research and clinical practice.
Arch Psychiatr Nurs 2000 Aug;14(4):163-72. The Psychogeriatric Assessment and Treatment in City Housing (PATCH) program for elders with mental illness in public housing: getting through the crack in the door. Robbins B, Rye R, German PS, Tlasek-Wolfson M, Penrod J, Rabins PV, Black BS. Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Psychogeriatric Assessment and Treatment in City Housing (PATCH) is an outreach program targeting elderly public housing residents who need mental health care. The PATCH model relies on educating housing personnel to serve as case finders, providing in-home psychiatric evaluation and treatment, and addressing medical and social comorbidities through case management by psychiatric nurses. An examination of PATCH interventions suggests that the program's success is due to its emphasis on: (1) educating patients, housing personnel, and caregivers about patients' illnesses and need for treatment and support; and (2) coordinating care among housing staff members, patients' caregivers and their primary medical providers.
JAMA 2000 Jun 7;283(21):2802-9. Effectiveness of a nurse-based outreach program for identifying and treating psychiatric illness in the elderly. Rabins PV, Black BS, Roca R, German P, McGuire M, Robbins B, Rye R, Brant L. Meyer 279, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-7279. pvrabins@jhmi.edu.
CONTEXT: Elderly persons with psychiatric disorders are less likely than younger adults to be diagnosed as having a mental disorder and receive needed mental health treatment. Lack of access to care is 1 possible cause of this disparity. OBJECTIVE: To determine whether a nurse-based mobile outreach program to seriously mentally ill elderly persons is more effective than usual care in diminishing levels of depression, psychiatric symptoms, and undesirable moves (eg, nursing home placement, eviction, board and care placement). DESIGN: Prospective randomized trial conducted between March 1993 and April 1996 to assess the effectiveness of the Psychogeriatric Assessment and Treatment in City Housing (PATCH) program. SETTING: Six urban public housing sites for elderly persons in Baltimore, Md. PARTICIPANTS: A total of 945 (83%) of 1195 residents in the 6 sites underwent screening for psychiatric illness. Among those screened, 342 screened positive and 603 screened negative. All screen-positive subjects aged 60 years and older (n=310) and a 10% random sample of screen-negative subjects aged 60 years and older (n=61) were selected for a structured psychiatric interview. Eleven subjects moved or died; 245 (82%) of those who screened positive and 53 (88%) of those who screened negative were evaluated to determine who had a psychiatric disorder. Data were weighted to estimate the prevalence of psychiatric disorders at the 6 sites. INTERVENTION: Among the 6 sites, residents in 3 buildings were randomized to receive the PATCH model intervention, which included educating building staff to be case finders, performing assessment in residents' apartments, and providing care when indicated; and residents in the remaining 3 buildings were randomized to receive usual care (comparison group). MAIN OUTCOME MEASURES: Number of undesirable moves and scores on the Montgomery-Asberg Depression Rating Scale (MADRS), a measure of depressive symptoms, and the Brief Psychiatric Rating Scale (BPRS), a measure of psychiatric symptoms and behavioral disorder, in intervention vs comparison sites. RESULTS: Based on weighted data, at 26 months of follow-up, psychiatric cases at the intervention sites had significantly lower (F(1)=31.18; P<.001) MADRS scores (9.1 vs 15.2) and significantly lower (F(1)=17.35; P<.001) BPRS scores (27.4 vs 33.9) than those at the nontreatment comparison sites. There was no significant difference between the groups in undesirable moves (relative risk, 0.97; 95% confidence interval, 0. 44-2.17). CONCLUSIONS: These results indicate that the PATCH intervention was more effective than usual care in reducing psychiatric symptoms in persons with psychiatric disorders and those with elevated levels of psychiatric symptoms. JAMA. 2000;283:2802-2809
Nurs Meas 2000 Summer;8(1):61-70. Assessing abuse among the elderly living in public housing. Moody LE, Voss A, Lengacher CA. University of South Florida, College of Nursing, Tampa 33612, USA.
Abuse and victimization among the elderly have received increased attention in the last few years from practitioners, researchers, and policymakers but remain growing problems, especially for elders who live in public housing. This study assessed the psychometric properties of an existing instrument, the Hwalek-Sengstock Elder Abuse Screening Test (HSEAST), which has been tested in only two studies. The instrument was administered to 100 African American, Hispanic, and White elders living in public housing. Study results were compared to findings from a previous study of elderly groups. A principal components factor analysis of the 15-item instrument supported the 3-factor structure for a total of 10 items (factor loadings = 0.4 or >), explaining 38% of the variance. A discriminant function analysis showed that 6 items were as effective as the 9-item model in classifying cases (71.4%) as abused.
ABNF J 2000 May-Jun;11(3):56-8. Exercise and dietary behaviors in African American elders: stages of change in efficacy expectancies. Davis L. Office of Nursing Research, School of Nursing, Graduate Nursing Program, Department of Family Health, Southern University, Baton Rouge, Louisiana 70813, USA.
The purpose of this pilot study was to measure and describe stages of change and efficacy expectancies of African American elders in regard to exercise and dietary behaviors. Elders who had hypertension (N = 37) were recruited from a senior center and a public housing building for the elderly. These elders were found to be in the action and maintenance stages of change. They believed that they were able to perform healthy exercise and dietary behaviors and that these behaviors were effective in relation to their hypertension. Implications of the finding are discussed in regard to exercise and dietary behaviors and health promotion programs for this high-risk population.
