Title: Older-aged schizophrenic patients in institutionalised residential
services: A challenge for mental health care provision?
Author: Thomas W. Kallert
[editorial article, in english]
Introduction. De-hospitalisation processes and demographic development constitute an increasing challenge for health service systems as regards mental health care provision of older-aged schizophrenic patients. Furthermore, ethical demands focus on good service quality for this sub-group of the elderly, in particular when they are in need of institutionalised residential care.
Methods. This paper reports results from longitudinal studies on important features indicating sensitive care issues in such treatment settings that have been identified via a systematic MEDLINE literature search. For schizophrenic cohorts middle-aged over 55 years the following areas are covered: mortality, extra-pyramidal symptoms, severity of psychopathological symptoms, severity of cognitive impairments, effectiveness of alternative community-based service models, predictors of subjective well-being, and costs of care.
Results. Apart from significant excess mortality, older-aged schizophrenic patients in nursing homes show high rates of tardive dyskinesia, severe and progredient psychopathological symptoms, and cognitive impairments equal in severity to those of persons with Alzheimer’s disease. Few studies having assessed alternative community-based service approaches produced inconsistent results on outcome domains. No replicated predictors for subjective well-being of this clientele have been identified so far. Direct health care costs seem to substantially exceed those for other somatic and mental illnesses.
Discussion. Systematic research in this increasingly extending field of mental health service provision is urgently needed. Of utmost importance would be to carry out comparative evaluation studies of service quality in different settings including cost-effectiveness analyses.
Conclusion. Without such empirical data, evidence-based health policy decisions in an ethically sensitive area of mental health care will not be made, and speculations on models of best institutionalised care will prevail.
Key words: schizophrenia, older-age, nursing care homes, service quality
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