The utility of self-rated health in older adults with schizophrenia.

OBJECTIVES: Self-rated health is one of the most widely used measures in gerontology, but it has not been evaluated systematically in older adults with schizophrenia (OAS). Therefore, the aim of this study was to determine the utility of self-rated health in OAS by examining its influencing factors and contrasting these findings with a community comparison (CC) group. METHOD: We compared 249 community-dwelling persons aged 55 years and older having a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnosis of schizophrenia arising before age 45 years with a demographically similar group of 113 older adults in the general community. Using a modified version of Ocampo's model of self-rated health, we identified 12 predictor variables within 5 dimensions. RESULTS: There were no significant differences in self-health ratings between the OAS and the CC groups. Six of the 12 variables in the model significantly correlated with self-rated health in both groups. In linear regression analysis, three variables were significantly associated with self-rated health in both groups: Center for Epidemiological Studies-Depression score, number of physical disorders, and perception of self-health versus others. Self-rated health assessment was not associated with positive or negative symptoms or lack of awareness of mental illness. CONCLUSION: There was a striking similarity in the factors influencing self-rated health in the two groups. The findings were consistent with results of previous gerontological studies that self-rated health reflects elements of psychiatric and physical well-being, as well as perceptions of their age peers. Our results support the use of self-rated health as a legitimate clinical and research measure in OAS.

Recovery and Recovering in Older Adults with Schizophrenia: A 5-Tier Model.

RATIONALE: There are little recent data on clinical recovery in older adults with schizophrenia. This exploratory study uses an empirically measurable construct to address this issue. METHODS: From an original sample of 248 community-dwelling persons aged 55 and over with early-onset schizophrenia spectrum disorder, a subsample of 102 persons was reassessed at a mean of 52 months. Clinical recovery required meeting criteria for its two components: clinical remission and community integration. RESULTS: Prospective analysis generated a 5-tier taxonomy of recovery in which 12% remained persistently in clinical recovery at both baseline and follow-up (Tier 1) and 18% never met criteria of clinical recovery (Tier 5). The remaining 70% exhibited a variety of components of clinical recovery at baseline and follow-up (Tiers 2, 3, and 4). CONCLUSION: The findings generated a dynamic picture of recovery, with most persons being in varying states of "recovering." The 5-tier taxonomy of recovery adumbrated potential treatment strategies for each tier.

Advances in the Conceptualization and Study of Schizophrenia in Later Life: 2020 Update.

A crisis looms as research and clinical programs have not kept pace with dramatic increases in the number of older adults with schizophrenia. This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously.

Advances in the Conceptualization and Study of Schizophrenia in Later Life.

A crisis looms as research and clinical programs have not kept pace with dramatic increases in the number of older adults with schizophrenia. This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously.

Late-life psychosis: diagnosis and treatment.

Psychosis is one of the most common conditions in later life with a lifetime risk of 23 %. Despite its high prevalence, late-onset psychosis remains a diagnostic and treatment dilemma. There are no reliable pathognomonic signs to distinguish primary or secondary psychosis. Primary psychosis is a diagnosis of exclusion and the clinician must rule out secondary causes. Approximately 60 % of older patients with newly incident psychosis have a secondary psychosis. In this article, we review current, evidence-based diagnostic and treatment approaches for this heterogeneous condition, emphasizing a thorough evaluation for the "six d's" of late-life psychosis (delirium, disease, drugs dementia, depression, delusions). Treatment is geared towards the specific cause of psychosis and tailored based on comorbid conditions. Frequently, environmental and psychosocial interventions are first-line treatments with the judicious use of pharmacotherapy as needed. There is an enormous gap between the prevalence of psychotic disorders in older adults and the availability of evidence-based treatment. The dramatic growth in the elderly population over the first half of this century creates a compelling need to address this gap.