Advancing Research on Empirically-Supported Interventions for Older Adults Living with Serious Mental Illness

Presenter

Jovier Evans, Ph.D.
Division of Translational Research

Goal

The goal of this concept is to support research that addresses the optimization, effectiveness, implementation, coordination, and sustainability of empirically-supported therapeutic and services interventions within and across care settings to better meet the mental health needs of older adults with serious mental illness (SMI).

Rationale

Given the rapidly aging population, there is an urgent public health need for therapeutic and services research addressing practice-relevant questions and conducted within and across settings where older adults with SMI are likely to be identified as needing or receiving care. Despite the heightened risk of medical comorbidity, poor functioning, institutionalization, early mortality, and socioeconomic costs associated with SMI in later life, older adults with SMI remain under-identified and undertreated. While effective therapeutic and services interventions exist for younger and middle-aged adults with SMI, few have been adapted and implemented to address the needs of older adults. For example, age-related cognitive and physiological changes, co-occurring health conditions, and other individual and interpersonal factors (e.g., social supports and isolation, physical mobility, and residential status) are often not sufficiently considered or addressed in spite of evidence supporting their association with intervention outcomes and the extent to which older adults seek, receive, and adhere to mental health care. Factors associated with the health care system also serve as barriers to caring for older adults with SMI, such as inadequate access to specialty mental health care; poor coordination of psychiatric, medical, and social services; limited number of geriatricians, mental health and other providers (e.g., assisted living and nursing home staff, emergency department and hospital staff) with the knowledge to identify and provide care to older adults with SMI; and challenges associated with the transition from general adult health care and housing to geriatric services.

Some progress has been made in establishing an evidence base for effective therapeutic and services interventions in later life, however these efforts tend to be specific to late-life depression or anxiety disorders, and few studies focus on the development and implementation of comprehensive, evidence-based practices specifically for older adults presenting with other types of SMI. Moreover, access to and implementation and coordination of evidence-based interventions for SMI for older adults in community practice or service settings (e.g., primary care and geriatric specialty clinics, home health care, assisted living and long-term care facilities, and community-based programs) remains limited.

The proposed concept would foster research that supports the optimization of empirically-supported treatment and services interventions as well as testing of innovative implementation strategies for the delivery, organization, adoption, and sustainability of evidence-based mental health care for older adults with SMI. Research related to adapting and implementing efficacious treatment of SMI and strategies to improve clinical outcomes that include the reduction of co-occurring chronic health conditions among aging populations, is encouraged. Collaborative research combining multidisciplinary expertise to address SMI and improve access to evidence-based interventions in later life, such as research to evaluate the administration of the health system, interventions that facilitate care transitions and continuity across settings, and research on strategies to improve care linkages and coordination across systems, is also encouraged.