Outcome Among Community Dwelling Older Adults with Schizophrenia: Results Using Five Conceptual Models

Abstract

There have been few studies examining the outcome of schizophrenia in later life. Using five conceptual models, we test two hypotheses with respect to range of outcomes among older schizophrenia outpatients and how they compare to their age peers in the community. We operationalized five outcome measures from the following conceptual models: Remission, adapting criteria of Andreasen et al. (The American Journal of Psychiatry, 162:441-449, 2005); Recovery, adapting the criteria by Liberman et al. (International Review of Psychiatry, 14:256-272, 2002); Community Integration using the model of Wong and Solomon (Mental Health Services Research, 4:13-28, 2002); Subjective and Objective Successful Aging using the model of Rowe and Kahn (Science, 237:143-149, 1987). The schizophrenia (S) group consisted of 198 community-dwelling persons aged 55 and over who developed schizophrenia before age 45 and a community comparison (CC) group (N = 113). Remission and recovery criteria were met by 49 and 17% of the S group, respectively. There were significant differences between the S and CC groups in the distribution of community integration and successful aging scales: 41% of the CC group met at least 10 of 12 criteria versus 23% of the S group on the Community Integration Scale; 19% of the CC group met all six criteria vs. 2% of the S group on the Objective Successful Aging Scale; 27% of the CC group vs. 13% of the S group met all six criteria on the Subjective Successful Aging Scale. Correlations among the five outcome measures ranged from r = .19 to .48 (median value: r = .26 or 7% shared variance). There is wide variability in outcome in later life depending on which measure is used. Rather than one universal indicator, each measure offers a different perspective that can provide useful guidelines for researchers, clinicians, and policy makers.

Successful Aging in Older Adults With Schizophrenia: Prevalence and Associated Factors

“…This contrasts sharply with other outcomes in the recovery continuum in which we found that nearly half attained clinical remission and one-sixth attained “objective recovery” (operationalized as clinical plus functional remission) (31). …”

“…We excluded some putatively significant predictor variables that overlapped with the dependent variable. The following instruments were used to derive the independent and dependent variables: (a) Center for Epidemiological Studies Depression Scale--CES-D(20), which was dichotomized into depressed and not depressed on the basis of a score of ≥ 8 which indicates depression with possible scores ranging from 0 to 80 (most depressed); (b) Positive and Negative Symptom Scale(PANSS)(21), from which we used the seven items each assessing positive and negative symptoms with each scale ranging from 1 to 7 (most severe); (c) the Financial Strain Scale (22) with possible scores ranging from 0 to 12 (least strain); (d) Abnormal Involuntary Movement Scale (23) with possible scores ranging from 0 to 42 (highest levels of dyskinesia); (e) the Quality of Life Index(24), a measure of self-perceived quality of life (satisfaction and importance) based on 33 items with possible scores ranging from 0 to 30; (f) the Dementia Rating Scale (25), that consists of subscales for attention, initiation and perseveration, construction, conceptualization, and memory, with possible scores ranging from 0 to 144 (higher cognitive functioning); (g) the Multilevel Assessment Inventory and the Physical Self-Maintenance Scale (26) from which we derived a summed score of the number of physical illnesses, the 7-item Basic Activities of Daily living Scale (BADL), and the 9-item Instrumental Activities of Daily Living Scale (IADL) (lower scores indicate more impairment); (h) the Cognitive Coping Scale, a 7-item with possible scores ranging from 0 to 7 derived from coping items proposed by by Pearlin and coauthors (27); (i) Lifetime Trauma and Victimization Scale (28), a 12-item scale based on the number of times persons experienced trauma or victimization such as crime victim, assault, physical or sexual abuse, incarceration with possible scores ranging from 0 to 36 (highest frequency); (j) the 4 item CAGE for alcoholism (29); (k) the Network Analysis Profile (30) that was used to derive two variables: the proportion of contacts providing sustenance assistance (e.g., money, food, help with health care) and proportion of persons who could be relied on; (l) the 6-item subjective successful aging score(31) with possible scores ranging from 0 to 6 (subjectively most satisfied); (k) the mean of the sum of the frequency of 5 mental health services (psychiatrist for medication, group treatment, individual psychotherapy or behavioral therapy, day program, family therapy) divided into those in the upper tercile (coded 1) versus those in the lower two terciles (coded 0).…”

Psychosocial rehabilitation and quality of life for older adults with serious mental illness: recent findings and future research directions

“…A second paper, also by Cohen and colleagues [3**], complements the Cohen et al [2**] review with a theoretical approach to evaluating functional outcomes for older adults with SMI. The authors applied five constructs, including three taken from the field of mental health (remission, recovery, and community integration), and two from the field of aging research (subjective and objective indicators of “successful aging”).…”

Beyond Assessment of Quality of Life in Schizophrenia

“…Though rate and time to response differed markedly between expert-and self-rated measures, the combined symptomatic, functional, and subjective outcome was best predicted by an early response in QOL ). However, though interventional studies confi rmed that symptomatic remission could be reached at average by 40-60 % of patients with schizophrenia, remission frequencies differ markedly between different patient populations (e.g., acute versus stabilized patients or fi rst versus multiple episodes of psychosis) (Lambert et al 2006(Lambert et al , 2008(Lambert et al , 2010aBobes et al 2009 ;Helldin et al 2007 ;Cohen et al 2009 ;Schennach-Wolff et al 2009 ). Moreover, studies have shown that symptomatic remission is not necessarily associated with QOL improvement Karow et al 2012a ).…”