Schizophrenia Into Later Life: Treatment, Research, and Policy by Carl I. Cohen

Author:Carl I. Cohen
Language: eng
Format: mobi
Tags: Psychiatry, Medical, General
ISBN: 9781585627349
Publisher: American Psychiatric Pub
Published: 2003-05-27T21:00:00+00:00

P • A • R • T IV

Treatment and Service

Issues

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C • H • A • P • T • E • R 10

What Are the Service

Needs of Aging People

With Schizophrenia?

Suzanne Meeks, Ph.D.

Colin A. Depp, M.A.

As will be evident from many of the chapters in this book, much of what we have recently learned about schizophrenia in late life comes from stud-

ies of inpatient populations (see also Meeks 2000). These studies, and the

few that have focused also on outpatients, have in the past decade greatly improved our knowledge about schizophrenia in the latter half of the life span. However, inpatient studies are limited in their ability to inform us about the service needs of elderly people with schizophrenia. Inpatients are to some extent homogeneous in their service needs: they are all experiencing severe enough symptoms to disrupt their community functioning and usually are in need of medication and support sufficient to restore a base level of functioning so that they can be discharged. What symptoms continue to be problematic after discharge? To where, to whom, and to what kind of ongoing treatment are they discharged? What are the factors that maintain them in their community residences? What factors contribute to the most positive quality of life? These are the broad questions that seem most pertinent to ascertaining the service needs of this population. For this reason, we focus in this chapter on outpatients, using what we know from our own data and from our review of other published work. In the absence

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SCHIZOPHRENIA INTO LATER LIFE

of formal needs assessment, we examine what is known about the characteristics of older people with schizophrenia and the needs that are implied by these characteristics. We then examine current data about service utilization and, finally, examine possible models for service structure and delivery.

Psychiatric Characteristics and Implied Service Needs

Naturally, the first question we ask with regard to service delivery is “What are the psychiatric symptoms and secondary characteristics that must be treated?” Long-term follow-up studies examining the natural history of schizophrenia have suggested that there may be a general improvement in the condition of affected persons in later life (e.g., see Chapter 2 [Harding]

in this volume for a review). However, there is also considerable heterogeneity in late life among people diagnosed with schizophrenia, both in terms of long-term course of the disorder and in terms of late-life functioning

(e.g., Ciompi 1980; Meeks and Murrell 1997; Meeks et al. 1990). Thus, it

is unclear what general trends toward improvement may mean in terms of treatment needs.

Despite the possibility of improvement with age, our data suggest that it is relatively unusual for elderly individuals with schizophrenia, including those who are not currently in continuous contact with treatment centers,

to be symptom-free (Meeks and Murrell 1997; Meeks et al. 1990). In our

most recent data set of older and middle-aged adults with severe mental ill-

ness (see Meeks and Murrell 1997 for a description of the full study), we

had 124 participants who met Research Diagnostic Criteria (RDC; Spitzer

et al.

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