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Adequacy of Medical Treatment Among Older Persons With Schizophrenia

Dr. Vahia is affiliated with the Stein Institute for Research on Aging and the Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., 0664, La Jolla, CA 92093 (e-mail: ivahia{at}ucsd.edu). Dr. Diwan, Dr. Bankole, and Dr. Cohen are with the Department of Psychiatry and Dr. Nurhussein is with the Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn. Ms. Kehn and Dr. Ramirez are with the Department of Psychology, Long Island University, New York. The findings in this article were presented in part at the 2006 annual meetings of the American Association for Geriatric Psychiatry, March 10–13, San Juan, Puerto Rico, and the American Psychiatric Association, May 20–25, Toronto.

OBJECTIVE: This study used Krause's model of illness behavior in later life to examine factors associated with adequacy of medical treatment in a racially diverse sample of older patients (age 55 and over) with schizophrenia. METHODS: In a cross-sectional community study, 119 persons were identified from a sample of 198 persons with schizophrenia age 55 or older who developed the disorder before age 45; for comparison, 57 persons were identified from a group of 113 without the disorder. The groups were compared for treatment of one or more of four common medical disorders. Thirteen independent variables were inserted into Krause's model for the comparisons. A dependent variable was created to indicate whether persons received medication treatment for all of their medical disorders (high-treatment group). RESULTS: Significant differences were found between the schizophrenia and control groups in the proportion receiving treatment for the four physical conditions (.61 versus .83, respectively, p=.004). By logistic regression, four of 13 variables for the schizophrenia group were significantly associated (p<.01) with being in the high-treatment group: absence of depression, lower frequency of medical visits, fewer positive symptoms, and more negative symptoms. CONCLUSIONS: Although older patients with schizophrenia and their age peers had similar levels of physical disorders and rates of health visits, the former received less adequate treatment. More aggressive management of comorbid depression and positive symptoms of schizophrenia may help in improving the health of this population.

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Psychiatr Serv 2008 59: 835. [Full Text] [PDF]

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