Certified Older Adult Peer Support Specialists Telephonic Intervention to Support Independent Living Skills in Older Adults with Serious Mental Illness
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PROJECT SUMMARY Adults aged 50+ years with a serious mental illness (SMI) make up 2.9% of the United States population, yet account for 12.7% of healthcare dollars. SMI is defined as schizophrenia spectrum disorder, bipolar disorder, and treatment-refractory major depressive disorder. Older adults with SMI experience 6-9 chronic health conditions, limited self-management skills (i.e., daily activities to take care of one’s medical and psychiatric health, such as medication adherence), and impaired independent living skills (i.e., ranging from personal hygiene to money management and work functioning). Moreover, our team found greater independent living skills of older adults with SMI at baseline predicted aging-in-place 12 months later (i.e., residence in a home or apartment without needing in-home support services). As such, few older adults with SMI maintain the capacity to age-in-place. Our work has contributed to developing an emerging workforce of certified older adult peer specialists that can address some of the above intervention access barriers. Certified older adult peer specialists are a Medicaid-reimbursable workforce of individuals aged 50+ years with lived experience of aging with a mental health diagnosis who are hired, trained, and accredited to offer peer support. Usual delivery of such peer support typically involves unstructured support around mental health coping. Our recent work has built on such peer support and offers a more structured 12-week telephonic-based intervention called Supporting Older Adults Remotely (SOAR) tied to evidence-based self-management strategies for medication adherence. Promising evidence indicates SOAR is feasible, acceptable, and may support medication adherence, independent living skills, and aging-in-place in older adults with SMI. We propose to conduct a fully powered Type 1 Hybrid Effectiveness-Implementation randomized controlled trial of SOAR, compared to Peer Support as Usual on independent living skills (proximal), medical and psychiatric self- management and medication adherence (proximal) and aging in place (distal). We will also examine whether medical self-management, psychiatric self-management, and medication adherence (target mechanisms) predicts independent living skills. Resident participants will include 200 older adults with SMI who report poor independent living skills (score of < 40 on the Independent Living Skills Survey) from 2 supportive housing residences serving racially/ethnically diverse communities. Residents will be randomized across residences to either SOAR (n=100) or Peer Support as Usual (n=100). Follow-up quantitative data collection will occur at 3, 6, and 12 months. Qualitative interviews with relevant parties will assess barriers and facilitators for adopting telephonic peer support interventions in supportive housing.
