Care needs of elderly people with schizophrenia: Assessment of an epidemiologically defined cohort in Scotland
McNulty SV, Duncan L, Semple M, Jackson G A and Pelosi AJ;
Commented by , 21 Mar 2003
Aim of the Study
To measure the care needs of over 65s with chronic psychosis in a defined catchment area, using a standardised assessment.
Method
Patients with schizophrenia over 65 in the Hamilton and Bellshill area of Lanarkshire, were identified in 1998 from relevant case records. They had a home address in the (socially deprived) study area, or were in long term care and had been originally admitted from a Hamilton or Bellshill address.
A broad definition of schizophrenia was used using DSM-III-R criteria; schizophrenia, schizophreniform disorder, delusional disorder, atypical psychosis, and schizoaffective disorder. Those with learning disabilities fulfilling criteria were included.
All psychiatric case notes of potential study participants were examined by a research psychiatrist using OPCRIT, a symptom checklist that generates standardised diagnoses.
Subject to consent, the psychiatrist then interviewed all patients using the Cardinal Needs Schedule, comprising 6 subscales that assess clinical and social function. One of these was the REHAB (Rehabilitation Evaluation Hall And Baker), a widely used standardised scale rating behaviour and self care.
Results
95 patients met initial inclusion criteria, of whom 5 were excluded because of comorbid dementia. Of the remaining 90, 81 were diagnosed as schizophrenia, 3 delusional disorder, and 6 atypical psychosis.
Mean age was 73.9 years, 68 % were female, and 59 % had onset of illness after age 45. 56 % were living in their own homes in the community, others were living in a variety of institutional residences.
64 % consented to interview; this group was broadly representative of the total sample. Of this (interviewed) group, widespread psychopathology and functional deficits were detected:
- 65 % positive symptoms of schizophrenia
- 56 % negative symptoms of schizophrenia
- 23 % clinically significant depression and/or anxiety
- 35 % parkinsonism
- 62 % tardive dyskinesia
- 60 % significant cognitive impairment.
46 participants completed the REHAB scale, mean score 75. In general, clinical features and needs were high wherever participants resided, though cognitive impairment, medication side effects, and negative symptoms were significantly higher in the long stay participants. However, community residents had higher depression/anxiety scores.
The data was also analysed according to whether participants were receiving input from the Community Mental Health Team; these patients had more needs, ie., the Community Mental Health Team were seeing a more seriously ill group.
Discussion
The main finding was the level of disability in this group. This was higher than a study in the same area in the mid-1990s using similar methodology in the 18-65 age group.
Are the results of this study transferable? The authors acknowledge that their study was in an area of high social deprivation with low resource levels. Also, the Cardinal Needs Schedule may not be sensitive to some specific needs, and 25 % of the sample did not participate in the interview phase of this study and may have had different needs.
However, this is valuable research in a neglected area. The comorbid physical problems and cognitive impairment lead the authors to conclude that adequately resourced old age psychiatry services are required to provide long term follow up for these patients.