Family contact and health status among older adults with serious mental illnesses

Life situation of older people living with severe mental illness - A scoping review

An increasing number of older people with severe mental illness (SMI) poses additional challenges to healthcare and social services. This scoping review aimed to investigate the life situation of older people living with severe mental illness and identify the research gaps in the existing literature. The current review followed the methodological framework for conducting scoping reviews by Arksey and O'Malley, consisting of five main stages: (1) identifying the research question (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising, and reporting the results. An optional sixth stage, a consultation exercise, has also been used in this study: The scoping review was conducted in accordance with the PRISMA extension for scoping reviews PRISMA-ScR, and the databases PsychINFO Scopus, Cinahl, Web of Science and PubMed were used. A total of 24 studies were included in the review. The thematic analysis focused on: (1) the perspective of older people with SMI, (2) the perspective of healthcare professionals supporting older people with SMI, and (3) the perspective of informal carers supporting older people with SMI. The results describe the life situation of older people living with SMI, especially in relation to the older peoples' experiences of suffering and well-being. The staff and the informal carers need adequate knowledge to provide support to the older people with SMI. To gain greater knowledge about the life situation and support needed by older people with SMI, we strongly advocate additional research focusing on their own experiences.

Experiences Using Family or Peer Support for Smoking Cessation and Considerations for Support Interventions: A Qualitative Study in Persons With Mental Health Conditions

Background: The current study aimed to understand how people with mental health conditions who currently smoke or recently quit engaged with family members or peers when quitting and assessed interest in involving family or peers in cessation interventions. Methods: Adults with mental health conditions who smoke or had quit within the past 5 years were recruited from publicly funded mental health programs (N = 24). We conducted virtual qualitative interviews between November 2020 and August 2021 and analyzed the data using the rapid thematic analytic approach. Results: Most participants were men (62%), and 71% were current smokers. We found that: having family/peers who were interested in quitting presented communal quitting opportunities, communication that facilitated quitting tended to be encouraging, and strong relationships with family members increased willingness to involve them in cessation interventions. But family or peer support was less helpful for individuals who were not ready to quit. Conclusion: Training family and peers to engage in supportive behaviors may promote cessation in this population. Cessation interventions may benefit from recruiting support partners who share a strong relationship with the smoker.

Considerations of Family Functioning and Clinical Interventions

Levels of family functioning are an important consideration in determining appropriate clinical and educational intervention approaches for families and older adults. Theoretical and applied approaches are reviewed with the emphasis on specific interventions that support different levels of family functioning and caregiving. Additionally, different dynamics within the family and their relations with aging family members are examined. This paper updates and expands discussions on levels of family functioning considerations by Sterns et al. using Blocher’s theory of level of human effectiveness. Further levels of family functioning include the theories developed by Bowen’s family systems theory. A present-day consideration is important for counseling, case management, caregiving, and treatment planning to assist families and their aging family member.

Developing an assessment tool for geropsychiatric mental healthcare knowledge and attitude evaluations in clinical practice for nursing students

AIM

To develop an instrument to investigate geropsychiatric psychological symptoms, health problem nursing knowledge (GPN-K), geropsychiatric psychological symptoms and health problem nursing attitude scale (GPN-A) in clinical practice for nursing students.

DESIGN

Instrument development and cross-sectional study for psychometric testing.

METHODS

Construct validity was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA), and internal consistency was calculated using Cronbach's α.

RESULTS

A total of 300 students have completed the questionnaires (85.71% response rate). The CFA of GPN-K showed good fitness and validity. The Kuder-Richardson 20 (KR-20) value of the internal consistency reliability is 0.64. The GPN-A overall content validity index is 0.95. A three-factor structure was shown by exploratory factor analysis. The three factors are communication and care, helping others improve and problem evaluation tendency. The total variance explained is 59.01%. Cronbach's alpha of GPN-A equals 0.84, which represents good internal consistency.

Exploring the Role of the Internet, Care Quality and Communication in Shaping Mental Health: An Analysis of the Health Information National Trends Survey

Determinants of user mental health are diverse, interrelated, and often multifaceted. This study explores how internet use, perceived care quality, patient education, and patient centered communication influence mental health, using structural equation modeling. Findings suggest that increased internet use even for health purposes negatively impacts mental health (= -0:087; = -0:065; P < 0:001). On the other hand, education level, patient centered-communication (PC-Com) and perception of care quality impact mental health positively (= 0:082; = 0:146; = 0:077; P < 0:001; respectively). Moreover, we also explored the changes across various demographics. The influence of patient education on PC-Com was only significant for Hispanic respondents (= -0:160; P < 0:001). Internet use for health purposes influenced P C-Com negatively for White American respondents (= -0:047; P = 0:015). The study reinstated that the internet use, patient centered communication, patient education, and perceived care quality might influence mental health. The society will increasingly seek health information from online sources, so our study provides recommendations to make online health information sources more user friendly and trustworthy, ultimately to minimize negative impact on mental health.

The Prevalence of Depressive and Insomnia Symptoms, and Their Association With Quality of Life Among Older Adults in Rural Areas in China

Background: There are few studies on the epidemiology of depression, insomnia, and their association with quality of life (QOL) in older adults living in rural China. This study examined the prevalence of depressive and insomnia symptoms, and their association with QOL in community-dwelling older adults in a rural area in Anhui province, China. Methods: This was a cross-sectional study conducted in the rural areas of four cities (Hefei, Huaibei, Anqing, and Xuancheng) in Anhui province between July and October, 2019 using random sampling method. All community-dwelling residents from the selected villages who met the study entry criteria were invited to participate in this study. Depressive and insomnia symptoms and QOL were assessed with the Chinese version of self-reported Center for Epidemiological Survey Depression Scale (CES-D), the Insomnia Severity Index (ISI) and the 26-item World Health Organization Quality of Life Brief version (WHOQOL-BREF), respectively. Results: A total of 871 older adults were included. The prevalence of overall depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms were 34.0% [95% confidence intervals (95% CI): 30.8-37.1%], 45.7% (95% CI: 42.4-49.0%) and 20.3% (95% CI: 17.6-23.0%), respectively. Older adults with depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms had lower scores in QOL compared to those without. Depressive symptoms were positively associated with living with families [Odd Ratio (OR) = 1.82, 95% CI: 1.31-2.54] and negatively associated with current drinking (OR = 0.49, 95% CI: 0.33-0.72). Insomnia symptoms were negatively associated with fair and good financial status (fair: OR = 0.53, 95% CI = 0.38-0.75; good: OR = 0.30, 95% CI = 0.14-0.64) and current drinking (OR = 0.64, 95% CI = 0.45-0.93), and positively associated with more frequent major medical conditions (OR = 1.32, 95% CI = 1.16-1.51). Comorbid depressive and insomnia symptoms were positively associated with living with families (OR = 2.02, 95% CI = 1.36-3.00), and negatively associated with fair and good financial status (fair: OR = 0.61, 95% CI = 0.41-0.89; good: OR = 0.34, 95% CI = 0.12-0.95) and current drinking (OR = 0.57, 95% CI = 0.35-0.92). Conclusion: Depressive and insomnia symptoms were common in older adults living in rural areas in China. Considering the negative health outcomes caused by depressive and insomnia symptoms, regular screening and effective treatments should be developed for this population.

Physical health status of older adults with severe mental illness: The PHiSMI-E cohort study

The objective was to use various somatic parameters as basis for investigating the physical health of older adults with severe mental illnesses (SMI). A cross-sectional study design is performed by using baseline data from the Physical Health in SMI-elderly (PHiSMI-E) study. Data were collected using the Nursing Monitoring of Somatic Status and Lifestyle - Mental Health instrument in adults aged over 60 with SMI in a large Dutch mental health institute. Ninety-nine elderly SMI patients were included. Somatic comorbidity (84.8%), use of somatic medication (77.7%) and polypharmacy (67.7%) were prevalent. Extrapyramidal symptoms were experienced by 51% of patients, mainly in the subgroup with psychotic disorders (75.6%). Unhealthy diet was reported in 16.2%, obesity in 27.3%, and physical inactivity in 57.6%. Fatigue (67.7%) and dry mouth (66.6%) were the commonest reported physical symptoms. Mean VAS score (scale 0-10) indicating participants' self-perceived physical health was 6.7 (SD ± 1.6). After division of the total patient group into tertiles based on the VAS scores, the lowest tertile was characterized by less physical activity, unhealthier diet, more use of medication, more fatigue, somnolence, and inner agitation. In conclusion, impaired physical health status was common in these older patients with SMI. Although they had more psychiatric and somatic comorbidity than adult SMI patients described in the literature, they had a healthier lifestyle. To reduce morbidity and premature mortality in these frail patients, it is essential that healthcare providers are aware of the high prevalence of somatic comorbidity and symptoms, and of their interactions with the psychiatric disorders. This study improves our understanding of differences in vulnerability factors of older patients with SMI. The (early) detection of somatic comorbidities may improve long-term health outcomes of these patients.

Effect of living with patients on caregiver burden of individual with schizophrenia in China

Caregiver burden may be especially high in China. However, there has been no empirical study comparing burden experienced by caregivers who live with their patient kin and caregivers live separately from their kin. This study compared caregiver burden in cohabiting and non-cohabiting families and examined characteristics that may account for observed differences ion experienced burden. Patients were evaluated on symptoms, insight, attitudes toward medication before discharge and their prime caregivers were evaluated on family burden shortly after admission. Bivariate analysis of covariance and multiple regression analyses were used to compare burden between these two groups and to identify factors that might account for observed differences between them. Of 243 schizophrenic patients, 4.9% lived with their primary caregivers. Caregiver burden was greater among caregivers living with patient kin on three factors, caregiver distress, disrupted routines and assistance provided by caregivers, but not on caregiver perceptions of behavioral problems or suicidality. Multiple regression analysis showed that living with caregiver explained 6.7%, 8.3% and 6.7% of the variance in distress, disrupted routines and helpfulness. Living with a patient was by far the strongest correlate of increased burden experienced by schizophrenia caregivers in this study and these caregivers should be offered community-based support.

Effect of a Family-Oriented Communication Skills Training Program on Depression, Anxiety, and Stress in Older Adults: A Randomized Clinical Trial

BACKGROUND

Older adults face several physical and psychological problems such as hearing loss, vision loss, and memory loss, which diminish the quality of their communication. Poor communication in turn affects their psychological wellbeing and induces substantial depression, anxiety, and stress. The family has an important role in the mental health of older adults.

OBJECTIVES

This study aimed to investigate the effect of a family-oriented communication skills training program on depression, anxiety, and stress in older adults.

PATIENTS AND METHODS

For this randomized controlled clinical trial, we enrolled 64 older adults from two healthcare centers affiliated to the Isfahan University of Medical Sciences. The subjects were randomly allocated to an experimental group (n = 32) and a control group (n = 32). In the experimental group, older adults along with their primary caregiver participated in six sessions of communication skill education. The control group participated in two training sessions on nutrition and exercise. All participants answered the DASS21 questionnaire three times-at the start of the study, at the end of the sixth week, and a month after the last educational session of the experimental group. Data were analyzed using chi-square, Fisher's exact and t tests and by repeated measures analysis of variance (ANOVA).

RESULTS

In the experimental group, the mean depression score significantly reduced from 10.56 ± 3.34 before intervention to 7.46 ± 2.80 and 6.30 ± 2.75 after intervention and at follow-up, respectively; the mean anxiety score significantly reduced from 8.46 ± 1.88 before intervention to 5.83 ± 1.93 and 5.80 ± 2.12 after intervention and at follow-up, respectively; and the mean stress score significantly decreased from 11.40 ± 4.53 before intervention to 8.90 ± 3.81 and 8.43 ± 3.31 after intervention and at follow-up, respectively (P < 0.05 for all three domains). In contrast, the control group did not show any significant change in the mean depression, anxiety, and stress scores.

CONCLUSIONS

Family-oriented education on communication skills could reduce depression, anxiety, and stress in the elderly. Therefore, such programs should be adopted as a non-pharmacological and cost-effective method for reducing depression, anxiety, and stress in older adults.

Mediation analysis of critical time intervention for persons living with serious mental illnesses: assessing the role of family relations in reducing psychiatric rehospitalization

OBJECTIVE

Critical Time Intervention (CTI) is a time-limited care coordination intervention designed to reduce homelessness and other adverse outcomes for persons living with serious mental illness during the transition period between institutions and community living. This study assesses whether CTI improves the quality of family relationships between family members and individuals living with serious mental illness, and examines whether changes in quality of family relationship mediated the association between the intervention and psychiatric rehospitalization outcomes.

METHOD

This study utilizes data from a randomized controlled trial that assessed the effect of CTI in preventing homelessness. Following discharge from inpatient psychiatric treatment in New York City, 150 previously homeless persons living with serious mental illness were randomly assigned to receive usual services only or 9 months of CTI in addition to usual services.

RESULTS

Findings from mixed-effects regression models indicated that those assigned to the CTI group reported greater frequency of family contact and greater improvement in satisfaction with family relations than the comparison group during the 18-month follow-up period. Mediation analysis revealed that greater improvement in satisfaction with family relations mediated the effect of CTI on psychiatric rehospitalization outcome, but only at a modest level.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

These findings suggest that a relatively brief but targeted intervention delivered at the point of hospital discharge may contribute to strengthening family relations and that improvement in perceived family relationship quality can contribute to a reduction in psychiatric rehospitalization.

A mixed methods exploration of family involvement in medical care for older adults with serious mental illness

OBJECTIVE

Many older persons with serious mental illness (SMI) suffer from high rates of comorbid medical conditions. Although families play a critical role in psychiatric illness management among adults with SMI, their contributions to improving health outcomes in this population has received little attention. This study explored family involvement in medical care for older adults with SMI.

METHODS

This mixed methods study involved analysis of quantitative data collected from older adults with SMI and cardiovascular risk (n = 28) participating in a pilot study of an intervention designed to improve patient-centered primary care augmented by qualitative interviews with their relatives (n = 13) to explore family involvement in medical care.

RESULTS

Approximately 89% of older adults with SMI reported family involvement in at least one aspect of their medical care (e.g., medication reminders, medical decision making). However, many family members reported that they were rarely involved in their relative's medical visits, and most did not perceive a need to be involved during routine care. Family members identified obesity as their relative's primary health concern and many wanted guidance from providers on effective strategies for supporting weight loss.

CONCLUSIONS

Although many family members did not perceive a need to be involved in their relative's routine medical visits, they expressed interest in talking with providers about how to help their relative change unhealthy behaviors. Educating patients, families, and providers about the potential benefits of family involvement in medical care, including routine medical visits for persons with SMI and cardiovascular health risk may promote patient- and family-centered collaboration in this high-risk population.

Factors associated with family-centered involvement in family practice--a cross-sectional multivariate analysis

The importance of a family-centered approach in family practice has been emphasized. Knowledge about factors associated with higher family-centered involvement seems beneficial to stimulate its realization. German office-based family physicians completed a questionnaire addressing several aspects of family-centered care. Logistic regression was used to identify associations with the involvement overall and in different domains: routine inquiry and documentation of family-related information, family orientation regarding diagnosis and treatment, family-oriented dialogues, family conferences, and case-related collaboration with marriage and family therapists. We found significant associations between physicians' family-centered involvement and expected patient receptiveness, perceived impact of the family's influence on health, self-perceived psychosocial family-care competences (overall and concerning concepts for family orientation, psychosocial intervention in family conferences, and the communication of the idea of family counseling), advanced training in psychosocial primary care (PPC), personal acquaintance with family therapists (regarding case-related collaboration), and rural office environment. Increased emphasis on the family's influence on health in medical education and training, the provision of concepts for a family-centered perspective, and versatile skills for psychosocial intervention and inquiry of patient preferences, as well as the strengthening of networking between family physicians and family therapists, might promote the family-centered approach in family practice.

Health behaviors as conceptualized by individuals diagnosed with a psychotic disorder

The purpose of this study is to describe health behaviors as conceptualized by individuals diagnosed with a psychotic disorder. Data were collected by qualitative interviews (n = 20) and were analyzed using phenomenography. Mental well-being took priority over physical health and guided health behaviors. Social relations were significant, and when they proved insufficient, health care professionals were utilized as a substitute. Some relied on religion, complementary treatments, and folk beliefs for health. Interventions not dependent on mental well-being, and assisting individuals to participate in appropriate networks could have advantages. Interventions adapted to the individual's financial situation and cultural values are useful as issues related to these areas can obstruct implementation of health behaviors. Implementing the findings of this study in nursing research and education will prepare nurses to meet the varying health needs of different individuals.

Beliefs about health, health risks and health expectations from the perspective of people with a psychotic disorder

AIM

To examine beliefs about health, health risks and health expectations from the perspective of people diagnosed with a psychotic disorder.

BACKGROUND

People with psychotic disorders have a threefold higher risk of developing physical health problems than the general population, and prevention of these problems is warranted. Examining patients´ health beliefs could help deepen our understanding of how to plan successful health interventions with this group.

METHODS

Qualitative semi-structured interviews were conducted from November 2010 to October 2011 with 17 people with psychotic disorders. Data were analyzed using a qualitative content analysis.

RESULTS

An overall positive picture of health was found despite the fact that physical health was found to be hard to verbalize and understand. Health was mainly associated with psychological wellbeing, while health risks were found to be related to uncertain bodily identity, troublesome thoughts and inner voices, and exclusion from society. Interest in learning, and visions and goals of health seemed to increase awareness of health risks and health expectations, while not worrying could be viewed as a hindrance for health expectations.

CONCLUSION

There is a lack of expressed awareness of physical health risks, but such awareness is fundamental to performing life-style changes [14]. Nurses thus have an important task to help patients understand and verbalize potential physical health risks, and to find out what motivates them to adopt health behaviors.

Perceived Social Support for Diet and Exercise Among Persons With Serious Mental Illness Enrolled in a Healthy Lifestyle Intervention

OBJECTIVE

There is a lack of research on social support for health behavior change among persons with serious mental illness who face disproportionate morbidity and premature death due to cardiovascular disease. This study examined social contact and the demographic, health and clinical characteristics associated with perceived social support for diet and exercise among persons living with serious mental illness enrolled in a healthy lifestyle intervention.

METHOD

Baseline data from two ongoing studies of the In SHAPE healthy lifestyle intervention for persons with serious mental illness were included in this analysis (N = 158). Cross-sectional analyses examined social contact and correlates of both negative and positive experiences of social support for diet and exercise. Multiple linear regression was used to assess the relationship between demographic characteristics, symptoms, health, and social support.

RESULTS

The majority (80.3%) of participants reported face-to-face contact at least twice monthly with a family member or friend. Readiness to change physical activity was associated with greater criticism from family for exercise behaviors, r(64) = .29, p < .05. Depressive symptoms (β = .30, p < .01) were significantly associated with more unhealthy family eating environments while controlling for the amount of family contact (β = .27, p < .01), while readiness to change dietary portion size (β = .34, p < .01) was associated with encouragement for healthy eating from friends.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Participants had regular contact with significant others who were a source of both positive and negative support for healthy eating and exercise. Engaging natural supports in supporting healthy behaviors may help persons with serious mental illness initiate and maintain lifestyle change.

Age and physical health as predictors of family contact among adults with severe psychiatric illness

We assessed the association of frequency of family contact with age and physical health for a sample of adults with severe psychiatric illness (N = 171). This cross-sectional, observational study measured frequency of face-to-face and telephone contact with family members; satisfaction with family relations; and severity of participants' chronic or permanent physical health conditions. In this sample of adults with severe psychiatric illness, having a physical health condition and advancing age correlated negatively with frequency of face-to-face contact with family members. However, a hierarchical regression analysis controlling for residence in a family member's home, and participants' ratings of satisfaction with family relations, showed that the combination of being older and having more severe health conditions was associated with a more frequent rate of family contact than would be expected based on age or physical health considered alone. Because almost all older participants in this heterogeneous sample had serious physical health conditions, as well as frequent telephone and face-to-face contact with their family members, we recommend the recruitment of family members as collaborators in illness management interventions for aging and mid-life adults with psychiatric illness.