Late-life schizophrenia: Early- versus late-onset

Abstract

Self-perceived quality of life (QOL) is an important outcome indicator in schizophrenia and a predictor of symptomatic and functional improvement. This study provides the first large scale longitudinal study of the fluctuations, predictors, and impact of QOL in older adults with schizophrenia spectrum disorder (SSD).The sample consisted of 104 community-dwelling persons with SSD aged 55 and over (mean age: 61years) who developed the disorder prior to age 45. Mean follow-up was 52.5 months (range 12–116 months); 55% were men; 55% were white. We identified 22 potential predictor variables and used the Quality of Life Index (QLI) to assess QOL.There were no significant group differences in the QLI at baseline and follow-up. However, 33%, 24% and 43% of persons exhibited > 0.5 effect size increase or decrease, or no change, respectively. In multivariable analysis, there were 5 baseline predictors of QLI at follow-up: QLI, Center for Epidemiological Studies-Depression Scale (CES-D) scores, religiousness, perceived well-being versus others/past self, and time from initial interview. Baseline QLI predicted 5 variables at follow-up: the Positive and Negative Syndrome Scale (PANSS) anxiety score, PANSS positive score, CES-D score, insight, and perceived well-being versus others/past self.In many persons with SSD, QOL is not static in later life and one third improved their QOL. Effectively treating depressive symptoms and encouraging religious participation may improve QOL. QOL had two pivotal roles: As a relatively independent dynamic outcome measure and as a critical variable affecting clinical outcomes such as anxiety, depressive and positive symptoms.