Schizophrenia in Older Adults

Schizophreniain Older Adults

Schizophreniain Older Adults

Accordingto Felmet, Zisook &amp Kasckow (2011), researchers have overlookedthe issues of schizophrenia in the elderly. In the past decades, over90 percent of the published studies have excluded the older adultswith schizophrenia. Nonetheless, about 23.3 percent of the patientsdevelop the disease after forty years. Schizophrenia is the mostsevere mental illness that affects all aspects of life includingthought, judgment, mood, perception, and personality (Felmet, Zisook&amp Kasckow, 2011). The diagnosis and treatment process ofschizophrenia in the elderly is challenging for the researchers andclinicians due to the occurrence of other depressive disorders thatoverlap with the condition. According to Felmet, Zisook &amp Kasckow(2011) about 1.1 percent of the older adults in the United Stateshave schizophrenia in given year, which adds up to approximately 2.5million people.

Today,the worldwide prevalence of schizophrenia is one percent withtwo-thirds of those turning chronic. Although research shows thatelderly with schizophrenia do not have more health problems ascompared to their aging peers, their sicknesses may be more severe.As described by Felmet, Zisook &amp Kasckow (2011) the mortalityrates among schizophrenia patients have been projected to be up tofour times the rates in other healthy adults. According to research,Schizophrenia mainly results from a combination of environmental andgenetic factors.

Althoughschizophrenia is unpreventable, detecting the symptoms early enoughoffers a better chance to stop the worst symptoms of the illness(Felmet, Zisook &amp Kasckow, 2011). After exhibiting the firstsigns, schizophrenia often becomes chronic and continues throughoutan individual’s life with varying levels of intensity. The symptomscan be positive such as delusion, disorganized speech, andhallucination while negative signs include restricted emotions andinability to engage in productive activities. Then again, the elderlymay exhibit cognitive symptoms, which are associated withintellectual functioning. For example, the patients may have problemskeeping and recalling information. Although the cognitive problemsmay be subtle, they make it difficult for adults with schizophreniato manage daily activities (Felmet, Zisook &amp Kasckow (2011).


Nursinghomes and psychiatric hospitals

Aschbrenneret al. (2011) explain that schizophrenia is a progressive diseaseassociated with cognitive and functional decline. Therefore, patientsrequire medical care and treatment through placement options. Olderadults with schizophrenia can also be treated in nursing homes orpsychiatric hospital facilities. These centers are the mostrestrictive because the patients have to follow rules and aparticular routine. The health care professional regularly monitorsthe behavior and reaction to various treatment methods (Aschbrenneret al. (2011). Hence, it benefits the patients in regulating theadverse symptoms that can worsen the condition. The centers provide asafe place for the adults with schizophrenia to gather themselves andlearn how to take medication so that they can return to theirfamilies as soon as possible.

Evenso, Aschbrenner et al. (2011) describe that the contact with therelatives is limited because they have to follow to the visitingrules. Therefore, it is hard for the family members to provideregular assistance. Besides, these centers do not provide support forthe relatives because it only caters for the patient. Nevertheless,the arrangement may be expensive hence, the payment can be madethrough the medical insurance. For instance, Medicaid programs coverthe health care costs for the older adults in these public assistancefacilities. According to Aschbrenner et al. (2011), the centers areresponsible for the elderly as they have to guarantee that thepatient is protected and his or her needs are met. The court has aresponsibility to ensure that these facilities follow the law andprovide sufficient care for the older with schizophrenia.Consequently, the court can take necessary legal actions against thenursing home or psychiatric hospital if the patients are mistreatedin any way.


Thehousing centers operated privately are also used to house theschizophrenia patients. Aschbrenner et al. (2011) explain that thefacilities offer individualized care where the medical professionalclosely monitor the patients’ progress. On the other hand, thepsychiatrists study every individual in the facility and devise thebest treatment option that will reduce the symptoms. The centersoffer recreational programs, group therapy, and social rehabilitationdepending on the hospital. However, these facilities are veryexpensive and require patients who can cover the bills or have greatmedical insurance. Likewise, the private housing centers areresponsible for the patients thus, the court holds them liable ifthe residents are put at risk during their stay (Aschbrenner et al.(2011). Besides, the centers managed through private practice arerestrictive, and family members do not have frequent contact with thepatients.


Lastly,current data shows that approximately 85 percent of older people withschizophrenia live in the community. Aschbrenner et al. (2011)illustrate that community-based option uses a team of caregivers whomake regular contact with the patients to monitor the progress of thecondition, treatment adherence, and evaluate their health andpsychological needs. Therefore, this placement option benefits theolder adults because they are offered practical assistance.Additionally, the centers provide emotional support for the familymembers.

Asexplained by Aschbrenner et al. (2011), schizophrenia has a profoundimpact on families hence, giving them education and emotionalsupport ensures that they can assist the relative suffering from thecondition. The community-based housing is the least restrictivebecause the residents have close contact with the family members andfriends (Aschbrenner et al., 2011). These centers reduce the level ofstigma for both the patient and their relatives. Therefore, the olderadults with schizophrenia are accepted in their societies thus, theyare less lonely and have a greater quality of life despite theircondition. These facilities are affordable, and the family can usethe medical insurance. However, the relatives are liable for thepatient, but the court has a responsibility to ensure that theseindividuals are treated well.

Theoriesand Treatments

Schizophreniais recognized through a steady decline in logical thinking, behavior,and social skills. These issues can interfere with functioning atwork, personal relationships, and self-care because it is a lifelongdisease. As older adults realize what it means to have the condition,they may become demoralized or depressed. Therefore, schizophreniarequires a combination of treatments including social support,psychotic drugs, and counseling. Psychological approaches have becomeessential in reducing the symptoms and effects of schizophrenia. Thepsychotherapists can apply the cognitive and family systems theoriesto model the patients’ behavior and attitudes of their family.


Asexplained by Jauhar et al. (2014) cognitive behavioral therapy (CBT)is increasingly used to treat schizophrenia. Since the 1950s, the CBThas been considered an effective approach to treating mentaldisorders. CBT h is highly standardized and structured approach toassist schizophrenia patients to cope with the psychotic symptoms byexamining and reassessing their thoughts and views of experiences.The treatment helps the elderly change the way they behave, think,and feel. According to Jauhar et al. (2014), CBT is based on thetherapist’s ability to build trust and actively engage the client.For instance, it is crucial to collaborate with the patient tounderstand the meaning and extent of the symptoms. The counselorassists the elderly to make sense of what he or she perceives to bean overwhelming problem by breaking it into manageable sections.Besides, the CBT techniques intend to help the adults stop thenegative cycles associated with schizophrenia.

Intheir study, Jauhar et al. (2014) show that CBT is used to reduce thesymptoms and suffering caused by schizophrenia. When dealing withelderly schizophrenics, the therapist emphasizes on the patient’sexperiences and explains the symptoms in a realistic way to reducethe distressing effect. Consequently, it benefits the client to feeloptimistic because they learn skills they need to handle theirsituation instead of feeling demoralized. Nonetheless, this can onlybe successful if the counselor accepts the patient’s perception ofreality and decides how to use those misrepresentations to assist theclient to manage his or her life (Jauhar et al., 2014).

Onthe other hand, this approach may not be beneficial to every olderperson with schizophrenia due to unique personal experiences.Besides, older adults with schizophrenia do not acknowledge that theyhave the condition, which makes it hard to collaborate (Jauhar etal., 2014). Furthermore, treating schizophrenia with CBT ischallenging because the therapist has to teach the patient social,problem solving, and daily functioning skills, which is hard toaccomplish with older adults. Some research has shown that CBTbenefits the client by reducing the positive symptoms and recoverytime as compared to other standard care and psychological approaches.However, it has not yet provided evidence of decreased negative andpersistent severe psychotic symptoms. In spite of this, the evidenceon CBT supports its use among older adults with schizophrenia thus,it has being included as one of the primary treatment approaches(Jauhar et al., 2014).

Familysystems theory

Thenagain, the therapists can use family systems theory to treat olderadults with schizophrenia. The concept was developed by Murray Bowen,which suggests that it is difficult to understand an individual’sactions if he or she is isolated from others. According toRus-Calafell et al. (2015), each member has a role to play in thefamily, which determines how they respond to each other. Relativesmaintain similar patterns of behaviors to keep a balance, but it canalso lead to dysfunction. Therefore, their actions and attitudestowards the person with schizophrenia affect the recurrence ofpositive symptoms thus, influencing the progress of the condition.

Rus-Calafellet al. (2015) explain that the therapist can use the theory to helpthe family and patients cope with illness and reduce thevulnerability of relapse. The approach is helpful when the olderadults lack insight into their condition, or they are unable tocommunicate logically about the progress of their behaviors. On theother hand, the relatives usually have information about the changesin behaviors, stability, and moods hence, they can assist inexplaining what has been happening to the patient. Besides, therelatives are the primary caregivers for patients thus, involvingthem in the treatment process is crucial to its success. As stated byRus-Calafell et al. (2015) the family interventions can reduce therate of relapse and the need for hospitalization. The therapist canteach the family members how to manage medication and build a supportnetwork.

However,critics of family systems theory indicate that it can be risky usingthis approach due to the lack of boundaries. According toRus-Calafell et al. (2015), schizophrenia symptoms includehallucinations and delusion, and this makes the patients skeptical ofsharing intimate information with the therapist. For example, theelderly may feel vulnerable when talking about the problems andsymptoms associated with the condition. Lastly, research shows thatthe psychotic medications in combination with either family-focusedinterventions or cognitive behavior therapy are the most beneficialform of treatments for older adults with schizophrenia.


Aschbrenner,K., Grabowski, D. C., Cai, S., Mor, V., Bartels, S. J. (2011).Nursing home admissions and long-stay conversions among persons withand without serious mental illness. Journalof Aging &amp Social Policy, 23(3),286-304.

Felmet,K, Zisook, S., &amp Kasckow, J. W. (2011). Elderly patients withschizophrenia and depression: Diagnosis and treatment. ClinicalSchizophrenia&amp RelatedPsychoses, 4(4),239-250.

Jauhar,S, McKenna, P. J., Radua, j., Fung, E, Salvador, R, &amp Laws, K. R.(2014). Cognitive-behavioral therapy for symptoms of schizophrenia:systematic review and Meta analysis with examination of potentialbias. TheBritish Journal of Psychiatry,204(1),20-29.

Rus-Calafell,M., Caqueo-Urizar, A, Urzua, A, Escudero, J., &ampGutierrez-Maldonado, J. (2015). The role of family therapy in themanagement of schizophrenia: challenges and solution. JournalofNeuropsychiatricDisease and Treatment,11,145-151.