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Does Supported Living in Residential Homes Improve the Quality of Life and Mental Stability of Older Adults With Chronic Mental Disorder?

Received November 14, 2003; revised March 3, 2004; accepted March 9, 2004. From the Netherlands Institute of Mental Health and Addiction (MD,RG), Utrecht University Medical Centre, Department of Psychiatry (TH), and Division of Old Age Psychiatry at the Altrecht Institute for Mental Health Care (TH), Utrecht, the Netherlands. Address correspondence and reprint requests to Ms. Marja Depla, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands. e-mail: mdepla{at}trimbos.nl
© 2005 American Association for Geriatric Psychiatry

Objective: Supported living in residential homes for the elderly is an innovative, age-appropriate residential program for older adults with chronic mental disorders. The program involves 1) accommodation in ordinary "elder care" homes; and 2) provision of on-site mental health care by professionals from the local psychiatric hospital. The authors asked whether the program succeeds in improving the patients’ quality of life without compromising their mental stability. Methods: Patients in 18 supported living programs (N=96) were compared with similar patients in eight psychiatric hospitals (N=78), in a cross-sectional study. Quality of life was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS) and the Manchester Short Assessment of Quality of Life (MANSA). Mental stability was assessed in terms of rehospitalizations, adjustments in medication because of symptom exacerbation, and 6-month prevalence of psychotic symptoms. Results: After adjustment for patient characteristics, the supported-living participants experienced a significantly lower quality of life than the hospital patients, as indicated by two of the three PGCMS subscales and by the MANSA. Disparities were greatest in the subgroup of patients with psychotic disorders. No significant differences in mental stability were found between the two conditions. Eleven of the 96 supported-living participants had undergone temporary rehospitalization since their entry into the program. Conclusions: Supported living in residential homes for elderly persons is an attractive model, but it does not automatically guarantee the participants a better quality of life. Further research is needed to determine which program characteristics can improve results.

Key Words: Psychiatric Hospitalization • Assisted Living