Direct assessment of functional status in older patients with schizophrenia

Abstract

T he evaluation of functional status can be accomplished by three types of assessment: patients' reports, caregivers' reports, and direct observation of performance. Research has shown low rates of agreement between self-reported and actual performance of activities of daily living among elderly hospitalized patients (1). In addition, caregivers' reports of patients' functioning have been noted to be unreliable in some cases (2). For older outpatients with schizophrenia there is often a paucity of available caregivers (3). The direct evaluation of behaviors essential to daily living provides a more objective index of an individual's ability to complete relevant tasks. Behavior-based assessments, however, often evaluate skills targeted for specific populations or skills related to institutional care. Such shortcomings tend to reduce the sensitivity of these measures to detect subtle changes in functioning (4).A performance-based protocol has been developed to assess directly a broad range of functional abilities in older individuals. The Direct Assessment of Functional Status Scale (4) involves the assessment of behavior during simulated daily activity tasks. Unlike other performance-based measures, which tend to provide information regarding primarily basic, lower-level skills and appear most applicable to institution-based care, this scale assesses a wide range of behaviors that are generalizable to outpatients and ambulatory care settings. It covers seven areas having to do with time orientation, communication, transportation, finance, shopping, grooming, and eating. Within each area, specific tasks that simulate real-world activities are performed (e.g., for the dimension of time orientation, the participant is asked to tell time at each of four progressively more difficult clock settings with the use of an analog clock; the participant is also tested on orientation for time and date).Loewenstein and colleagues (4) reported that the Direct Assessment of Functional Status Scale significantly discriminated clinic patients with Alzheimer's disease from normal elderly subjects and from a group of elderly outpatients with major depression. To our knowledge, the measure has not been tested in a group of older patients with schizophrenia. The present study was conducted to compare the functional abilities of middle-aged and elderly patients with schizophrenia with those of normal subjects, by means of the Direct Assessment of Functional Status Scale, and to determine the predictors of functional disability in the patients.

Longitudinal Network Structure and Changes of Clinical Risk and Protective Factors in a Nationwide Sample of Forensic Psychiatric Patients

“…Our findings are in line with previous studies showing that impulsivity leads to use of maladaptive coping strategies ( Bornovalova et al, 2005 ; Kunst et al, 2010 , 2011 ; Vollrath & Torgersen, 2000 ), development of antisocial behavior ( Fornells et al, 2002 ; Maneiro et al, 2017 ; Moeller et al, 2001 ), and hostility and aggression ( Bresin, 2019 ; Scarpa, & Raine, 2000 ). In addition, our findings also found support in previous studies showing that psychotic patients were characterized with impaired everyday functioning ( Klapow et al, 1997 ; Viertiö et al, 2012 ) and that patients who were not able to satisfactorily maintain social contacts with his life- and work-environment were more prone to use maladaptive coping strategies ( Brunt & Hansson, 2002 ; Van Der Horst et al, 2010 ) and to develop antisocial behavior ( Coie & Dodge, 1998 ; Farrington & Loeber, 2001 ; Lösel & Beelmann, 2003 ). To support our novel findings, further investigation and replications in larger samples are needed.…”

Everyday action in schizophrenia: Performance patterns and underlying cognitive mechanisms.

“…Several studies have used performance-based measures to assess everyday action among individuals with schizophrenia (Evans et al, 2003;Klapow et al, 1997;Patterson et al, 1998;Patterson, Goldman, McKibbin, Hughs, & Jeste, 2001;Semkovska et al, 2002Semkovska et al, , 2004Twamley et al, 2002;Velligan et al, 1997). However, to our knowledge, no study has examined a complete array of action errors with a validated and well-researched measure.…”

Aripiprazole for late-life schizophrenia

“…Further, the impairment in social functioning characteristic of schizophrenia continues into older age, although either improvement or deterioration is possible 12. In this context, impaired cognitive function appears to predict poorer social functioning 13,14. Thus, compared with same age nonpsychiatric controls, older patients with schizophrenia have significantly more problems with finances, transportation, forming friendships, and looking after their home 14,15.…”

“…In this context, impaired cognitive function appears to predict poorer social functioning 13,14. Thus, compared with same age nonpsychiatric controls, older patients with schizophrenia have significantly more problems with finances, transportation, forming friendships, and looking after their home 14,15. They are also less likely to live independently and more likely to live in supervised settings 16.…”