As the number of older adults with schizophrenia grows and their care methods change, a global health crisis is looming. It’s estimated that people over 55 years are potentially going to represent 25% or more of all schizophrenia patients worldwide.
Little research is present on older patients with schizophrenia. In fact, this research only makes up 1% of schizophrenia literature. It is projected that schizophrenia will double in prevalence in older adults by 2025, reaching 1.1 million in the US and 10 million worldwide. It is imperative to address this population through research and policy initiatives sooner than later.
Risks and Complications
Older adults who have schizophrenia fall into two categories: “old-old” (those 75 and over) and “young-old” (those 55 to 74 years old). Schizophrenia patients in their older years include individuals whose disease began early and endured into their later years and those whose disease was diagnosed relatively late in life. Despite living longer than ever before, people living with schizophrenia still have a shorter life expectancy than people unaffected by this condition.
Schizophrenia patients are at an increased risk of mortality, and this gap has been growing in recent decades. Suicides and accidents cause more deaths in older people with schizophrenia than healthy peers.
Schizophrenia is commonly associated with congestive heart failure, chronic obstructive pulmonary disease, and hypothyroidism in older adults. Part of the reason for this is lifestyle factors such as poor diet, tobacco use, inactivity, and side effects of antipsychotic drugs. Given the limited knowledge of the mechanisms underlying the increased morbidity and mortality, further research is important to identify clinical and social risk factors that are adjustable for elderly patients with schizophrenia.
Older individuals are more susceptible to adverse side effects of antipsychotic drugs than younger individuals. There are many reasons for this like:
- Changes in pharmacokinetics that increase the elimination half-life
- Distributed volume of antipsychotic drugs
- Changes in permeability of the blood-brain barrier that increase drug availability in the brain
- Pharmacodynamic changes that decrease D2 receptor density and dopaminergic neurons in the brain as we age.
Aging also increases the risk of adverse effects associated with antipsychotics, such as Parkinson’s disease, tardive dyskinesia, falls, and metabolic syndrome. The adverse effects of these drugs can further impair cognitive and functional ability in older patients with schizophrenia.
How Symptoms Change Over Time
In general, positive symptoms of schizophrenia may decline as we age, while negative symptoms predominate. Several studies, however, have cast doubt on this assumption. A study of 18 global cohorts from the International Study of Schizophrenia (ISoS) found that 77% of patients did not experience a significant increase of negative symptoms over a 15- or 25-year period.
Likewise, an investigation into institutionalized geriatric schizophrenia patients showed that their negative symptoms generally did not change significantly over time. In clinical terms, negative symptoms do not predominate in older adults with schizophrenia. They often manifest in the same way in younger patients.
The Good News
In aging, we experience three areas of change: physical, cognitive, and psychosocial:
Physical– Hair loss, wrinkles become noticeable, and health deteriorates
Cognitive– Memories begin to get harder to recall. Cognitive functions also decline.
Psychosocial– We begin to feel worse about ourselves from cognitive impacts, becoming more withdrawn from society and relationships.
The aging process is part and parcel of being human. However, with chronic diseases and disorders like schizophrenia and other mental or physical ailments, aging can cause even more serious concerns.
Dr. Dilip Jeste has been continuously studying the effects of aging in 1,500 middle-aged and older people with schizophrenia for about 20 years and has found some very encouraging results. Although people with schizophrenia have a higher risk of developing certain physical illnesses than the general populace, they do not age any faster cognitively than those who do not have schizophrenia.
Interestingly, and more promising still, his research has shown that psychosocial functioning often improves with age rather than deteriorating. Many older adults with schizophrenia can now adhere to mental health treatment, have higher self-esteem, and enjoy a higher quality of life.
If you want to learn more information on aging and schizophrenia for yourself or a loved one, the Life Adjustment Team is eager to help. You can contact us and get started accessing help today.