Enhancing Psychosocial Function of Patients with Late-Life Schizophrenia
Mental Health and Geriatric Care
By 2025, 20% of individuals with schizophrenia will be 65 or older. Schizophrenia is one of the most debilitating and expensive mental disorders, especially in late life. Its burden is due to a large extent to deficits in abilities to live independently. Cognitive Behavioral Social Skills Training (CBSST) has been shown to improve skills of independent living among mid-life individuals with schizophrenia. With the support of this Innovation Fund, we conducted a randomized controlled trial and demonstrate that CBSST can stabilize those skills in older individuals with schizophrenia, age 60 or above. This stabilization is in contrast to significant decline in those skills among those who did not receive. CBSST is now part of the standard of care of older individuals with schizophrenia at CAMH. Front-line staff, including occupational therapists, social workers, nurses and others, have been trained on delivering CBSST in outpatient and inpatient settings.
Background: Schizophrenia in late life is one of the most debilitating and expensive mental disorders. Its burden is due associated deficits in social and instrumental functions. Cognitive Behavioral Social Skills Training (CBSST) aims at improving these functions. CBSST improves skills of independent living among mid-life individuals with schizophrenia. Thus, we conducted a randomized controlled trial to assess CBSST in individuals with late-life schizophrenia (LLS), age 60 years and older, in improving skills of independent living.
Methods: 63 participants with LLS were randomized to treatment-as-usual (TAU; N = 31; Mean Age = 64.7, SD = 4.3) or CBSST (N = 32; Mean Age = 65.8, SD = 6.1) for 9 months. Assessments were conducted at baseline, and at week 18, 36 and 52 post-baseline. Skills for independent living were assessed using the Independent Living Skills Survey (ILSS).
Results: 27 participants completed CBSST compared to 23 participants completing TAU. There was a significant interaction between group assignment and performance on ILSS at baseline and week-52. (F (1, 48) = 4.71, p = 0.035). Post-hoc analyses demonstrated that participants randomized to CBSST maintained same level of performance on ILSS at week-52 while those randomized to TAU declined significantly. The effect size of CBSST at week-52 was 0.6. Baseline performance on verbal memory predicted performance on ILSS in the CBSST but not TAU group.
Conclusions: CBSST prevents decline in community living skills in individuals with late-life schizophrenia. This effect is predicted by baseline memory function. These results support the use of CBSST in clinical settings that provide care to older individuals with schizophrenia. They also suggest that combining CBSST with an intervention that improves memory could further enhance the efficacy of CBSST.