Special Article
Schizophrenia and Older Adults: An Overview: Directions for Research and Policy

https://doi.org/10.1097/00019442-200002000-00003Get rights and content

The Group for the Advancement of Psychiatry, Committee on Aging, believes that a crisis has emerged with respect to the understanding of the nature and treatment of schizophrenia in older persons. Moreover, critical gaps exist in clinical services for this population. In this article, we examine the epidemiology of aging and schizophrenia; life-course changes in psychopathology, cognitive function, social functioning, and physical health; and various concerns regarding treatment, services, and financing. Finally, we propose six research and policy recommendations and suggest methods for addressing the research questions that we have posed.

Section snippets

An Emerging Crisis

A crisis has emerged in mental health care. It involves older persons with serious and persistent mental illness: those persons age 55 and over with longstanding illnesses such as schizophrenia, bipolar disorder, or chronic depressionβ€”who have been largely invisible to mental health researchers, providers, and policymakers. Approximately 2% of the population over age 54β€”about 1 million personsβ€”suffers from chronic mental illness other than dementia.1., 2. Over the next 30 years, their number

Where Do We Find Aging Persons With Schizophrenia?

Although the Epidemiologic Catchment Area study found prevalence rates of schizophrenia of only 0.3% among persons age 65 and over, this study tended to undersample in areas where persons with mental illness may be concentrated.19 The actual prevalence rate is probably about 1%,2., 5. and about 85% are living in the community. There has been a dramatic decline in the number of persons with schizophrenia living in mental institutions, and the Omnibus Budget Reconciliation Act (OBRA) regulations

How Does Schizophrenia Change Over the Life-Course?

In this section, we summarize the research and clinical practice literature. Interpretation of the literature on aging and schizophrenia requires an appreciation of a biopsychosocial life-course perspective that integrates the changes that occur over a lifetime among schizophrenic persons with the normal changes of aging in neuroendocrine systems, cognition, physical health, coping, and adaptation.3., 24., 25. Also, it should be noted that a limitation of the extant literature is that many

Recommendations

In sum, because the number of older persons with schizophrenia will increase dramatically over the ensuing decades, policymakers must begin to reorder research and service priorities to anticipate this growth. Our overview of the status of older persons with schizophrenia reveals that in many instances there are appreciable alterations in psychopathology, neuropsychological status, social functioning, and health that distinguish them from younger persons with the disorder. Nevertheless, the

References (109)

  • HH Goldman et al.

    Epidemiology of chronic mental disorder

  • BJ Gurland et al.

    Epidemiology of psychopathology in old age

    Psychiatr Clin North Am

    (1982)
  • CI Cohen

    Studies of the course and outcome of schizophrenia in later life

    Psychiatr Serv

    (1995)
  • Bartels S: Community service needs of severe and persistent mentally ill elderly. Presented at the American Psychiatric...
  • CI Cohen

    Outcome of schizophrenia into later life: an overview

    Gerontologist

    (1990)
  • E Light et al.

    The Elderly with Chronic Mental Illness

    (1991)
  • JH Patrick et al.

    Mothers' perception of service use and unmet service needs for their adult offspring with chronic mental illness

    Psychiatr Ann

    (1996)
  • GT Grossberg

    The older patient with psychotic symptoms: diagnostic and treatment advances

    Clinical Geriatrics

    (1997)
  • DV Jeste et al.

    Management of late-life psychosis

    J Clin Psychiatry

    (1996)
  • V Kumar

    Use of atypical antipsychotic agents in geriatric patients: a review

    International Journal of Geriatric Psychopharmacology

    (1997)
  • JP Lacro et al.

    New antipsychotics and antidepressants for elderly people

    Curr Opin Psychiatry

    (1996)
  • SM Maixner et al.

    The efficacy, safety, and tolerability of antipsychotics in the elderly

    J Clin Psychiatry

    (1999)
  • DV Jeste et al.

    Psychoses

  • JP Lacro et al.

    Late-life psychoses

    Int J Geriatr Psychiatry

    (1992)
  • AE Harris et al.

    Late-onset schizophrenia: an overview

    Schizophr Bull

    (1988)
  • PV Rabins et al.

    The prevalence of psychiatric disorders in elderly residents of public housing

    J Gerontol Med Sci

    (1996)
  • JE Streim et al.

    Psychiatric aspects of nursing home care

  • National Center for Health Statistics

    The National Nursing Home Survey:1985 Summary for the United States

    (1987)
  • CE Siegal et al.

    Mental illness among the elderly in a large state psychiatric facility: a comparison with other age groups

  • Center for Mental Health Services: Additions and Resident Patients at End of Year, State and County Hospitals, by Age...
  • DA Adler et al.

    Schizophrenia and the life cycle

    Community Ment Health J

    (1995)
  • Group for the Advancement of Psychiatry

    Beyond Symptom Suppression: Improving the Long-Term Outcomes of Schizophrenia

    (1992)
  • CM Harding et al.

    Chronicity in schizophrenia: revisited

    Br J Psychiatry

    (1992)
  • J Angst

    European long-term studies of schizophrenia

    Schizophr Bull

    (1988)
  • L Ciompi

    Catamnestic long-term study on the course of life and aging of schizophrenics

    Schizophr Bull

    (1980)
  • TH McGlashan

    A selective review of recent North American long-term follow-up studies of schizophrenia

    Schizophr Bull

    (1988)
  • BJ Cohler et al.

    Schizophrenia and the adult life-course

  • TH McGlashan et al.

    The positive–negative distinction in schizophrenia: review of natural history validators

    Arch Gen Psychiatry

    (1992)
  • CI Cohen et al.

    Depression among older persons with schizophrenia who live in the community

    Psychiatr Serv

    (1996)
  • M Davidson et al.

    Severity of symptoms in chronically institutionalized geriatric schizophrenic patients

    Am J Psychiatry

    (1995)
  • P Liddle et al.

    Syndromes of schizophrenia: classic literature

    Br J Psychiatry

    (1994)
  • AJ Dwork et al.

    Senile degeneration and cognitive impairment in chronic schizophrenia

    Am J Psychiatry

    (1998)
  • R Heaton et al.

    Neuropsychological deficits in schizophrenics

    Arch Gen Psychiatry

    (1994)
  • TM Hyde et al.

    Is there cognitive decline in schizophrenia?

    Br J Psychiatry

    (1994)
  • MM Kurtz et al.

    Aging and schizophrenia

    Clinical Geriatrics

    (1998)
  • MF Green

    What are the functional consequences of neurocognitive deficits in schizophrenia?

    Am J Psychiatry

    (1996)
  • PD Harvey et al.

    Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: a comparison across treatment sites

    Am J Psychiatry

    (1998)
  • CM Harding et al.

    The Vermont Longitudinal Study of Persons With Severe Mental Illness, I: methodology, study sample, and overall status 32 years later

    Am J Psychiatry

    (1987)
  • Cited by (0)

    The authors are members of the Group for the Advancement of Psychiatry, Committee on Aging.

    We thank Dr. Dilip Jerte, Dr. M. Jackuelyn Harris, and Carole Lefkowitz for their assistance.

    View full text