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Comparison of older people with psychosis living in the community and in care homes

  • Emily Clancy (a1) and Robert C. Baldwin (a2)
Abstract
Aims and Method

To compare two groups of older people with chronic schizophrenia or delusional disorder living in the community and in care homes, along the domains of morbidity suggested by prior research. From the case-load of one old age psychiatrist, 22 individuals with chronic psychosis residing in care homes were compared to 23 living in their own homes. The measures used were: the Positive and Negative Symptom Score (PANSS; Kay et al, 1987); the Mini Mental State Examination (MMSE; Folstein et al, 1975); the Burvill Physical Illness Scale (Burvill et al, 1990); and an Activities of Daily Living Scale (IADL; Lawton et al, 1969).

Results

Those in care homes had significantly higher PANSS scores (38.9 v. 21.0, P<0.01), largely accounted for by significantly more deficit symptoms (14.2 v. 5.6, P<0.01). They also had poorer cognition and significantly greater impairment in daily-life activities but their medical condition was not significantly worse. Most were seen only by a psychiatrist.

Clinical Implications

The greater morbidity and disablement of older people with chronic schizophrenia or delusional disorder living in care homes is likely to be intrinsic to the disorder but does not appear to be taken into account in current service planning or delivery.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Burvill, P.W, Mowry, B. & Hall, W. D. (1990) Quantification of physical illness in psychiatric research in the elderly. International Journal of Geriatric Psychiatry, 5, 161170.
Department of Health (1999) National Service Framework for Mental Health: Modern Standards and Service Models. Department of Health.
Department of Health (2001) National Service Framework for Older People. Department of Health.
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975) ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 185198.
Harvey, P. D., Sterman, J. M., Richard, C., et al (1999) Cognitive decline in later life schizophrenia: A longitudinal study of geriatric chronically hospitalised patients. Biological Psychiatry, 45, 3240.
Jolley, D., Kosky, N. & Holloway, F. (2004) Older people with longstanding mental illness: the graduates. Advances in Psychiatric Treat, 10, 2734.
Kay, S. R., Fiszbein, A. & Opler, L. A. (1987) The Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Bulletin, 13, 261276.
Lawton, M. P. & Brody, E. M. (1969) Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.
McNulty, S.V., Duncan, L., Semple, M., et al (2003) Care needs of elderly people with schizophrenia. British Journal of Psychiatry, 182, 241247.
Royal College of Psychiatrists (2002) Caring for People who Enter Old Age with Enduring or Relapsing Mental Illness. College Report CR110, Royal College of Psychiatrists.
Woods, S.W. (2003) Chlorpromazine equivalent doses for the newer atypical antipsychotics. Journal of Clinical Psychiatry, 64, 663667.
World Health Organization (1993) The ICD–10 Classification of Mental and Behavioural Disorders. WHO.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Comparison of older people with psychosis living in the community and in care homes

  • Emily Clancy (a1) and Robert C. Baldwin (a2)
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