Aging in Place for Older Adults with Serious Mental Illness: An Evaluation of The Bridge's Aging Services Program in the United States.

Over the past fifty years, life expectancy for adults in the United States has increased from 69.9 to 78.9 years, and as a result, healthcare needs have evolved. (1) Research suggests that a combination of economic prosperity, advances in medicine, and improvements in homecare have contributed to individuals living healthier and longer lives. (2) With older adults living longer, and a subsequent increased risk of developing chronic diseases, there is a need for more comprehensive healthcare services. The National Center for Health Statistics notes that despite the population's increased risk of chronic diseases, healthcare utilization varies. (3) For example, adults age 65 and older use acute and primary care at lower rates, partially due to a shortage of physicians who specialize in geriatrics and transportation-related barriers to healthcare access. (4) However, about 30 percent of emergency department visits were by individuals between the ages of 65 and 85 who needed treatment for cognitive, functional, and sensory impairments and depression. (5) Thus, emergency and ambulatory services are commonly overused to treat non-life threatening conditions in older populations.

Aging Population & Quality of Life

Symptoms of mental health disorders often go untreated in the older population. A 2012 study conducted by Amy Byers, Patricia Arean, and Kristine Yaffe noted that there is a high level of unmet mental health needs in the older adult population in comparison to other age groups. (6) For example, in their study, 70 percent of older adults (n=348) with mood and anxiety disorders did not receive mental health treatment. (7) In addition, older adults with serious mental health issues are often isolated and benefit from increased social support to improve their quality of life. Interacting with family members and friends increases older adults' access to social networks and can increase their sense of belonging. (8) When family and friends are not present, older adults can also benefit from making connections with trusted staff members of supportive agencies. (9) Studies have shown that when older adults have increased social support they are more likely to report better physical and mental health outcomes than their counterparts who have limited outside support. (10) Having access to resources and emotional support can also improve stress coping mechanisms and strengthen an individual's access to tangible support. (11) This vulnerable population needs comprehensive and quality care that addresses the whole person to maintain their mental and physical health.

The Bridge: Aging Services Program

The Bridge is a non-profit organization in New York City with the mission of transforming the lives of the most vulnerable, including individuals with a history of homelessness, older adults, and people with chronic mental health conditions, by offering hope, support, and opportunity. (12) The Bridge serves adults with serious and persistent mental illnesses whose lifelong conditions impact daily functioning. The Bridge uses a variety of evidence-based rehabilitative services, such as vocational training and workforce development, mental health and substance abuse treatment, healthcare, housing, education, and arts programming. (13) The Bridge strategically created the Aging Services Program to provide comprehensive whole-person care to older adults with mental health issues by reducing barriers to aging in place, maintaining quality of life, and extending community tenure in supportive housing. (14) To be enrolled in the Aging Services Program, a client must be age 55 or older, live in The Bridge's supportive housing, and face aging-related barriers to aging in place. The Aging Services Program addresses gaps in care by offering individualized support to older adults with behavioral health and physical health conditions living in Bridge supportive housing. (15)

Research Study Goal and Objectives

This study was conducted to evaluate how clients enrolled in the Aging Services Program view the support they receive and assess if changes can be made, based on client feedback, to improve service delivery. This study will highlight the barriers clients face while enrolled in the Aging Services Program, the resources that help clients maintain their health and wellbeing, and offer recommendations to better meet clients' needs. The findings will provide insight on ways to effectively design, implement, and monitor the Aging Services Program, which has future plans of replication, to improve client care while also serving as a guide for other older adult-focused services seeking to improve client experiences.

Methods

This study occurred in August 2019, and used qualitative research methods. To be eligible for this study, participants had to be enrolled in the Bridge's Aging Services Program for at least three months and be at least 55 years old (some age exceptions are made for high-risk clients). Out of the 137 clients enrolled in the Aging Services Program, 30 clients who met the eligibility criteria were randomly selected. Participants from this sample were then contacted and recruited via telephone. The sample size of this study consisted of twelve clients who were willing to participate. Due to clients having various mental and physical health conditions, interviews were conducted in clients' homes except for one client who requested that the interview be conducted in the Aging Services staff office. The research team created a semi-structured interview guide to thoroughly capture participants' personal experiences and perceptions of the Aging Services Program, while leaving questions open-ended so clients felt they had the space to share and be heard.

One in-person interview was conducted with each participant to evaluate four indicators, as self-reported by clients: use of emergency and hospital services; quality of life while enrolled in the program; general impressions; and overall satisfaction with the program. Scheduled interviews lasted between fifteen and thirty minutes. Interviews were conducted by a researcher who only met each client once, during the interview, and was not a service delivery provider to ensure clients felt comfortable sharing feedback. Face-to-face interviews allowed the researcher to effectively probe and capture in-depth responses to the research questions. Interviews were recorded using two mechanisms, a cell phone and handheld voice recorder. The interviewer also took handwritten notes to further capture data. The field notes and recordings were secured, transcribed, and coded in a protected file. Qualitative content analysis was used to interpret and analyze common themes in the data. Due to the iterative nature of coding, themes were created, removed, and/or combined throughout the coding and analysis process. Five major themes were identified: communication, healthcare access and utilization, quality of life, general impressions of the Aging Services Program, and recommendations for improvement.

Ethical Considerations

The Aging Service team collaborated with CUNY's Center for Innovation in Mental Health and received approval from the City University of New York's Institutional Review Board (Study ID# 2019-0666). Participants gave verbal consent before participating in this study and their participation was voluntary. Researchers assigned each participant a...