Outcome among community dwelling older adults with schizophrenia: results using five conceptual models

There have been few studies examining the outcome of schizophrenia in later life. Using five conceptual models, we test two hypotheses with respect to range of outcomes among older schizophrenia outpatients and how they compare to their age peers in the community. We operationalized five outcome measures from the following conceptual models: Remission, adapting criteria of Andreasen et al. (The American Journal of Psychiatry, 162:441-449, 2005); Recovery, adapting the criteria by Liberman et al. (International Review of Psychiatry, 14:256-272, 2002); Community Integration using the model of Wong and Solomon (Mental Health Services Research, 4:13-28, 2002); Subjective and Objective Successful Aging using the model of Rowe and Kahn (Science, 237:143-149, 1987). The schizophrenia (S) group consisted of 198 community-dwelling persons aged 55 and over who developed schizophrenia before age 45 and a community comparison (CC) group (N = 113). Remission and recovery criteria were met by 49 and 17% of the S group, respectively. There were significant differences between the S and CC groups in the distribution of community integration and successful aging scales: 41% of the CC group met at least 10 of 12 criteria versus 23% of the S group on the Community Integration Scale; 19% of the CC group met all six criteria vs. 2% of the S group on the Objective Successful Aging Scale; 27% of the CC group vs. 13% of the S group met all six criteria on the Subjective Successful Aging Scale. Correlations among the five outcome measures ranged from r = .19 to .48 (median value: r = .26 or 7% shared variance). There is wide variability in outcome in later life depending on which measure is used. Rather than one universal indicator, each measure offers a different perspective that can provide useful guidelines for researchers, clinicians, and policy makers.