People with 'late-life schizophrenia' include two distinct groups:
1. Those who developed schizophrenia early in life and are now middle-aged or elderly. As growing numbers of individuals with schizophrenia reach older age, there will be an increasing demand on the mental health system in Australia to accommodate the complex psychiatric, medial and social needs of this population. There is limited data about the course of schizophrenia in later life. What has been observed, however, is that the rate and frequency of hospitalisation diminishes as patients grow older. Additionally, ageing among patients with schizophrenia tends to result in a diminution of positive symptoms and therefore a reduced need for rehospitalisation for acute episodes (Auslander & Jeste 2002); and
2. Those with 'late-onset schizophrenia', who developed the symptoms of schizophrenia after the age of 45 years. Women tend to develop schizophrenia at a later age than men (Castle & McGrath 2000; American Psychiatric Association 2002) and symptoms are more likely to include paranoid delusions and hallucinations and less likely to include disorganised and negative symptoms (Auslander & Jeste 2002).Individuals in this older group have often experienced a better occupational history and have more often been married. Family studies seem to indicate that late-onset schizophrenia is less inheritable than early-onset schizophrenia (Jeste et al. 1995).
Issues for people with late-life schizophrenia
Differing medication requirements
Research indicates that antipsychotic medications are often effective for people with late-life schizophrenia and as a result, they require less medication. Older people, particularly those over the age of 70, no longer metabolise medication well and are therefore more susceptible to side effects (Salzman & Tune 2001). Extrapyramidal side effects are of particular concern in older people as they often experience these effects more severely and the anti-cholinergic drugs used to counteract these symptoms are not as effective in this population (Sciolla & Jeste 1998). Furthermore, polypharmacy (the use of more than one medication) needs to be administered very carefully, if at all, in older people because of their increased sensitivity to the effects of medication.
Comorbid medical problems
The development of comorbid medical problems (that is having two or more medical conditions) is common in elderly people, and greatly complicates the effectiveness of diagnosing, treating and coping with schizophrenia (Auslander & Jeste 2002).
Interaction between normal ageing deficits and schizophrenia
People with late-life schizophrenia can have cognitive deficits associated with both schizophrenia and normal ageing (for example, slowed processing and increased distractibility) that may exceed the deficits seen in either state alone (McDowd et al. 1993).
Relative loss of family support
Many people with schizophrenia live with or gain support from their family. While this type of support may still be available if the person has had their own family, if the person's family of origin were the only caregivers, this type of family support can be lost to the older person with schizophrenia
Problems in the delivery of and access to services
Despite the improvements in the mental health system in New South Wales since the launch of the Burdekin Report in 1993, there are still many problems associated with delivery and access to services and resources for older people with a mental illness. These include (but are not limited to):
- lack of a specialised treatment service for older people with a psychiatric illness (general adult psychiatric services may not have adequate resources to care for the specific needs of older clients, while services for elderly people in general may not have the resources to address mental illness);
- difficulty in finding appropriate accommodation (People with late-life schizophrenia may be placed in inappropriate settings because of a general lack of hospital and residential beds for elderly people; the inability of psychiatric facilities to deal with the chronic physical ailments experienced by the elderly;
- the inability of nursing hostels and homes to deal with psychiatric problems);
- decreased access to services (physical problems often confine elderly people to their place of abode; home visits by mental health professionals are rare, so many elderly people simply do not have access to the services they require);
- rights may be denied (older people with a mental illness, especially those with a serious mental illness such as late-life schizophrenia, and their relatives are often not fully informed of their rights or are not given the opportunity to exercise their rights; and
- discrimination in health services (elderly people are more likely to receive drug treatment without being offered other treatment options; they are often given lowest priority in all mental health services and inappropriate treatment is often administered because of failure to recognise age-related complications).
The recent consultation paper on the National Mental Health Plan 2003-2008, lists "continuity of care across the lifespan' as one of its priority areas. It states that Australia's ageing population will require the enhancement of service provision for this part of the lifespan and suggests the following action: "Ensure that mental health care is responsive to the diverse needs of consumers across the lifespan and that treatment approaches are appropriate to the needs of different lifespan groups, particularly children, youth and older adults" (p 15).
For a list of references for this quality of life section on schizophrenia and late life, click here.
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