In recent years, a deinstitutionalization movement has been occurring in Canadian psychiatric institutions. Occupational therapists, experts in evaluating occupational performance, are key contributors to the selection of appropriate community housing environments. This study describes the global functioning, performance in activities of daily living, social behavior, cognitive status, and quality of life of 33 older adults with a severe and chronic mental illness, who were transferred from a psychiatric hospital to community facilities between 1995 and 1998. Evaluations were repeated five times, twice before discharge and three times after the transfer. Participants demonstrated stability in their global, social and ADL functioning over time. In general, participants required occasional intervention for management of social behaviors, moderate assistance in activities of daily living, and were highly satisfied with their community accommodation. The transfer to community settings did not lead to a significant deterioration in the participants' levels of global functioning and quality of life.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (4th ed.). Washington, DC: American Psychiatric Association.
2.
AndrewsF.M.WhiteyS.B. (1976). Social Indicators of Well-being/Americans' Perception of Life Quality. New York: Plenum Press.
3.
AnthonyW.A.CohenM.R.VitaloR. (1978). The measure of rehabilitation outcome. Schizophrenia Bulletin, 4, 365–383.
4.
ArnoldS.E.GurR.E.ShapiroR.M.FisherK.R.MobergP.J.GibneyM.R.GurR.C.BlackwellP.TrojanowskiJ.Q. (1995). Prospective clinicopathologic studies of schizophrenia: Accrual and assessment of patients. American Journal of Psychiatry, 152, 731–737.
5.
AtlerK.St. MichelG (1996). Maximizing abilities: Occupational therapy's role in geriatric psychiatry. Psychiatric Services, 47, 933–935.
6.
BakerF.DouglasC. (1990). Housing environments and community adjustment of severely mentally ill persons. Community Mental Health Journal, 26, 497–505.
7.
BakerF.IntagliataJ. (1982). Quality of life in the evaluation of community support systems. Evaluation and Program Planning, 5, 69–79.
8.
BelitskyR.McGlashanT.H. (1993). At issue: The manifestations of schizophrenia in late life: A dearth of data. Schizophrenia Bulletin, 19, 683–685.
9.
BridgeT.P.CannonH.E.WyattR.J. (1978). Burned-out schizophrenia: Evidence for age effect on schizophrenic symptomatology. Journal of Gerontology, 33, 835–839.
10.
CappeliezP.QuintalM.BlouinM.GagnéS.BourgeoisA.FinlayM.RobillardA. (1996). Les propriétés psychométriques de la version française du modified mini-mental state (3MS) avec des patients âgés suivis en psychiatrie gériatrique. Revue Canadienne de Psychiatrie, 41, 114–121.
11.
CiompiL. (1980). Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophrenia Bulletin, 6, 606–618.
CommengesD.GagnonM.LetenneurL.DartiguesJ.-F.Barberger-GateauP.SalamonR., & Paquid Study Group (1992). Statistical description of the Mini-Mental State Examination for French elderly community residents. The Journal of Nervous and Mental Disease, 180, 28–32.
14.
DavidsonM.HarveyP.D.PowchikP.ParrellaM.WhiteL.KnoblerH.Y.LosonczyM.F.KeefeR.S.E.KatzS.FrecskaE. (1995). Severity of symptoms in chronically institutionalized geriatric schizophrenic patients. American Journal of Psychiatry, 152, 197–207.
15.
DavidsonM.HarveyP.WelshA.PowchikP.PutnamK.M.MohsR.C. (1996). Cognitive functioning in late-life schizophrenia: A comparison of elderly schizophrenic patients and patients with Alzheimer's disease. American Journal of Psychiatry, 153, 1274–1279.
16.
DenckerK.GottfiresC-G. (1991). The closure of a major psychiatric hospital: Can psychiatric patients in long-term care be integrated into existing nursing homes?Journal of Geriatric Psychiatry and Neurology, 4, 149–156.
17.
Direction des Services de Réadaptation. (1998, May). Les Services Résidentiels avec Programmes de Support et de Réadaptation et le Service Support dans la Communauté. Montréal, QC: Hôpital Louis-H. Lafontaine.
18.
EndicottJ.SpitzerR.L.FleissJ.L.CohenJ. (1976). The global assessment scale. Archives of General Psychiatry, 33, 766–771.
19.
FisherA.G. (1997). Assessment of Motor and Process Skills (2nd ed.). Fort Collins, CO: Three Star Press.
20.
FisherA.G. (1999). Assessment of Motor and Process Skills (3rd ed.). Fort Collins, CO: Three Star Press.
21.
FisherA.G.KielhofnerG.BryzeK.DobleS. (1989, April). Assessing process skills in the developmentally disabled. Paper presented at the annual conference of the American Occupational Therapy Association, Baltimore, MD.
22.
FolsteinM.F.FolsteinS.E.McHughP.R. (1975). Mini-Mental Test: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Residents, 12, 189–198.
23.
FrappierC. (1997). Traduction et estimation de la fidélité d' un instrument de mesure du comportement social pour une clientèle âgée résidant en centre hospitalier psychiatrique de soins de longue durée. Unpublished master's thesis, Université de Sherbrooke, Sherbrooke, QC.
24.
GagnonM.LetenneurL.DartiguesJ.-F.CommengesD.OrgogozoJ.-M.Barberger-GateauP.AlpérovitchA.DécampsA.SalamonR. (1990). Validity of the Mini-Mental State Examination as a screening instrument for cognitive impairment and dementia in French elderly community residents. Neuroepidemiology, 9, 143–150.
25.
GeorgeL.K.LandermanR.BlazerD.G. et al. (1991). Cognitive impairment. In RobbinsL.N., & RegierD.A., (Eds.). Psychiatric Disorders in America (pp. 291–327). New York: Free Press.
26.
GoldsteinJ.M.DziobekJ.F.ClarkR.BassukE.L. (1990). Supportive housing for the chronically mentally ill/matching clients with community environments. The Journal of Nervous and Mental Disease, 178, 415–422.
27.
HardingC.M.BrooksG.W.AshikagaT.StraussJ.S.BreierA. (1987). The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 44, 718–726.
28.
HareA.P. (1981). Group size. American Behavioral Scientist, 24, 695–708.
29.
HarveyP.D.LombardiJ.LeibmanM.WhiteL.ParrellaM.PowchikP.MohsR.C.DavidsonM. (1996). Performance of chronic schizophrenic patients on cognitive neuropsychological measures sensitive to dementia. International Journal of Geriatric Psychiatry, 11, 621–627.
30.
HellmanI.D.GreeneL.R.MorrisonT.L.AbramowitzS.I. (1985). Organizational size and perceptions in a residential treatment program. American Journal of Community Psychology, 13, 99–109.
HullJ.T.ThompsonJ.C. (1981). Predicting adaptive functioning among mentally ill persons in community settings. American Journal of Community Psychology, 9, 247–268.
33.
KillianE.C. (1970). Effect of geriatric transfers on mortality rates. Social Work, 15, 19–26.
34.
KingdonD.TurkingtonD.MalcolmK.SzuleckaK.LarkinE. (1991). Replacing the mental hospital. Community provision for a district's chronically psychiatrically disabled in domestic environments?British Journal of Psychiatry, 158, 113–117.
35.
KruzichJ.M. (1985). Community integration of the mentally ill in residential facilities. American Journal of Community Psychology, 13, 553–564.
36.
KruzichJ.M.BergW. (1985). Predictors of self-sufficiency for the mentally ill in long-term care. Community Mental Health Journal, 21, 198–207.
37.
KruzichJ.M.KruzichS.J. (1985). Milieu factors influencing integration into community residential facilities. Hospital and Community Psychiatry, 36, 378–382.
38.
LawtonP.YaffeeS. (1970). Mortality, morbidity, and voluntary change of residence by older people. Journal of American Gerontological Society, 18, 823–831.
39.
Le ClairJ.K.SadavoyJ. (1998). Geriatric psychiatry subspecialization in Canada: Past, present, and future. Canadian Journal of Psychiatry, 43, 681–687.
40.
LesageA.ContandriopoulosA.P.ReinharzD. (1999). La désintitutionnalisation dans un grand hôpital psychiatrique québécois depuis 1989: Analyse des besoins de soins, des coûts et des aspects organisationnels. (Report No. RS-2771 N95). Québec, Canada: Rapport final déposé au programme conjoint en santé mentale du Conseil Québécois de la Recherche Sociale et du Fonds de la Recherche en Santédu Québec
41.
LiebermanM.TobinS.SloverD. (1971). The effects of relocation on long term geriatric patients. (Final Rep. project no. 17-1328). Illinois Department of Health & Committee on Human Development. Chicago, IL: University of Chicago.
42.
MacMillanM.HornblowA.BairdK. (1992). From hospital to community: A follow-up of community placement of the long-term mentally ill. New Zealand Medical Journal, 105, 348–350.
43.
MarksonE.CummingsJ. (1974). A strategy of necessary mass transfer and its impact on patient mortality. Journal of Gerontology, 29, 315–321.
44.
MarkusE.BlenckerM.DownsT. (1972). Some factors and their association with post-relocation mortality among institutionalized aged persons. Journal of Gerontology, 27, 376–382.
45.
MercierC.TempierR.RenaudC. (1992). Services communautaires et qualité de la vie: Une étude d'impact en région éloignée. Revue Canadienne de Psychiatrie, 37, 553–563.
46.
MercierC.CortensP.CaronJ. (1995). Echelle de satisfaction des domaines de vie. In CyrM., ToupinJ., & LesageA. (Eds.), Colloque sur l'Evaluation des Problèmes Psychosociaux chez des Personnes Psychotiques (pp. 7–8). Centre de Recherche Fernand-Seguin, Montreal, Quebec, Canada.
47.
NelsonG.HallG. BrentWalsh-BowersR. (1999). Predictors of adaptation of people with psychiatric disabilities in group homes, supportive apartments, and board-and-care homes. Psychiatric Rehabilitation Journal, 22 (4), 381–389.
48.
NieuwenhuizenC.V.ScheneA.H.BoevinkW. A.WolfJ.R.L.M. (1997). Measuring the quality of life of clients with severe mental illness: A review of instruments. Psychiatric Rehabilitation Journal, 20 (4), 33–41.
49.
OkinR.L.BorusJ.F.BaerL.JonesA.L. (1995). Long-term outcome of state hospital patients discharged into structured community residential settings. Psychiatric Services, 46, 73–78.
50.
PabloR.Y. (1977). Intra-institutional relocation: Its impact on long-term care patients. The Gerontologist, 17, 426–435.
51.
PinoC.J.RosicaL.M.CarterT.J. (1978). The differential effects of relocation on nursing home patients. The Gerontologist, 18, 167–172.
52.
RockwoodK.DobleS.E.FiskJ.D.MacPhersonK.M.LewisN. (1996). Measuring functional change in elderly adults with Alzheimer's disease. Final report to the Alzheimer Society of Canada. Halifax, NS: Dalhousie University.
StotskyB.A. (1967). A controlled study of factors in the successful adjustment of mental patients to nursing homes. American Journal of Psychiatry, 123, 1243–1251.
55.
TombaughT.N.McIntyreN.J. (1992). The Mini-Mental State Examination: A comprehensive review. Journal of American Geriatrics Society, 40, 922–935.
56.
TraceS.HowellT. (1991). Occupational Therapy in geriatric mental health. American Journal of Occupational Therapy, 45, 833–837.
57.
TrainorJ.N.Morrell-BellaiT.L.BallantyneR.BoydellK.M. (1993). Housing for people with mental illnesses: A comparison of models and an examination of the growth of alternative housing in Canada. Canadian Journal of Psychiatry, 38, 494–500.
58.
TruteB. (1986). Sheltered housing for the chronic psychiatric patient: The influence of operators of board and care facilities on community participation of their residents. Canadian Journal of Community Mental Health, 5, 31–38.
59.
TsuangM.T.WinokurG. (1975). The Iowa 500: Field-work in a 35-year follow-up of depression, depression, mania, and schizophrenia. Canadian Psychiatric Association Journal, 20, 359–365.
60.
WinokurG.PfohlB.TsuangM. (1987). A 40-year follow-up of hebephrenic-catatonic schizophrenia. In MillerN.E., & CohenG.D. (Eds.), Schizophrenia and aging (pp. 52–60). New York: The Guilford Press.
61.
WittelsI.BotwinickJ. (1974). Survival in relocation. Journal of Gerontology, 29, 440–443.
62.
WykesT.SturtE. (1986). The measurement of social behaviour in psychiatric patients: An assessment of the reliability and validity of the SBS schedule. British Journal of Psychiatry, 148, 1–11.
